Clinical Appeals Specialist LPN/RN
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POST DATE 9/13/2016
END DATE 11/16/2016
Cottonwood Heights, UT
JOB DESCRIPTIONJob Code: 08942-122972
Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
-Monitor insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons
-Identify coding or clinical documentation issues and work to correct the errors in a timely manner
-Identify problem accounts and escalates as appropriate
-Update the patient account record to identify actions taken on the account
-Work with guarantors to secure payment on account balances outstanding for clinical reasons
-Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
-Other duties as assigned
COMMUNICATION-communicates clearly and concisely, verbally and in writing
CUSTOMER ORIENTATION - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
INTERPERSONAL SKILLS able to work effectively with other employees, patients and external parties
PC SKILLS demonstrates proficiency in Microsoft Office applications and others as required
POLICIES & PROCEDURES - demonstrates knowledge and understanding of organizational policies, procedures and systems
BASIC SKILLS -able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
ability to read and interpret medical records
Associate s Degree preferred
At least one year case management experience required
Relevant education may substitute experience requirement
Last Edited: 08/01/2016