Clinical Appeals Specialist (RN/LVN)

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POST DATE 9/13/2016
END DATE 11/2/2016

HCA Healthcare Irving, TX

Company
HCA Healthcare
Job Classification
Full Time
Company Ref #
08950-114455
AJE Ref #
576162384
Location
Irving, TX
Experience
Entry Level (0 - 2 years)
Job Type
Regular
Education
Associates Degree

JOB DESCRIPTION

APPLY
Job Code: 08950-114455

Full-time

No Weekends

Parallon Business Solutions includes financial services, revenue operations, patient account services, health information management, and human resources for our non-hospital lines of business, allowing patient care delivery partners to direct all of their attention and commitment to quality patient care.

JOB SUMMARY - Handles appeals requiring clinical input or interpretation

KEY RESPONSIBILITIES

* 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

KNOWLEDGE, SKILLS & ABILITIES

* 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

* Clinical skills - ability to read and interpret medical records

EDUCATION

Associate's Degree preferred

EXPERIENCE

* At least one year case management experience required

* Relevant education may substitute experience requirement

CERTIFICATE/LICENSE - Current State RN or LPN/LVN License

Parallon Business Solutions is an equal opportunity employer, offering a great work environment, challenging career

Associate's Degree/College Diploma

Last Edited: 04/11/2016