Clinical Appeals Team Lead

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

HCA Healthcare Irving, TX

Irving, TX
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Associates Degree


Job Code: 08950-120745


No Weekends

Do you believe you have management potential* Do you have a passion for healthcare and helping others* Do you enjoy working in a fast-paced environment* Realize your leadership potential and apply today to be a Clinical Appeals Team Lead!

Parallon's Mission:
We serve and enable those who care for and improve human life in their communities.

Parallon, a division of HCA, is an industry-leading provider of patient financial and revenue cycle services to acute care providers across the United States. We are dedicated to our values and passionate about finding future leaders for our fast-growing divisions in the Dallas/Fort Worth area. Although we are the largest healthcare provider in the world and experts and leaders in revenue cycle services, we maintain a people-first culture and sense of community.

As the Clinical Appeals Team Lead, you will assist the Clinical Appeals Manager with training of the appeals department, perform daily appeals follow-up and monitor denial trends and issues.

Duties include, but are not limited to:

* Provides introductory and ongoing training and education to Clinical Appeals staff to ensure that policies and procedures are followed

* Meets with the Manager regularly to effectively communicate and resolve issues, set and prioritize goals and improve processes

* Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards

* Maintains established departmental policies and procedures, objectives, patient and customer service policies

* Assists manager with development and implementation of project and department action plans

* Monitors insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons

* Identifies coding or clinical documentation issues and work to correct the errors in a timely manner

* Identifies problem accounts and escalates as appropriate

* Updates the patient account record to identify actions taken on the account

* Works with guarantors to secure payment on account balances denied for clinical reasons

* Practice and adhere to the Code of Conduct philosophy and Mission and Value Statement

* Performs 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 onsistently 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 ystems

* Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate roperly, spell correctly and transcribe accurately

* Clinical skills - ability to read and interpret medical records

* Communication - communicates clearly and concisely, verbally and in writing


* Associate s Degree in nursing required.

* Prior supervisory experience preferred


* At least one year case management experience required

* At least three years of revenue cycle experience preferred


* Current State RN or LPN licensure required


Last Edited: 05/18/2016