Clinical Appeals Specialist (RN/LVN)
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POST DATE 9/13/2016
END DATE 11/2/2016
JOB DESCRIPTIONJob Code: 08950-114455
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
* 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
Associate's Degree preferred
* 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