SHIFT: No Weekends
Do you want to be a part of a family and not just another employee? Are you looking for a work environment where diversity and inclusion thrive? Submit your application today and find out what it truly means to be a part of a team.
We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.
The Clinical Appeals Nurse is responsible for providing clinical input or interpretation for denials that have remained unresolved or have been escalated under the Shared Service Center (SSC) operations pre-established protocols. This position will be critical in supporting the dispute resolution strategy focused on denial cash conversion. Tracking large case volumes efficiently and effectively, with technology, while providing the highest levels of customer service and attention to details is required.
Operational Duties (included but not limited to):
- Compose, edit, review, or otherwise support concise clinical evaluations for disputed claims through review and assessment of denial reconsideration documentation, payer denial documentation, medical records, other relevant documents; recommend next steps for resolution.
- Demonstrate understanding of use of all Medical Necessity software, including but not limited to InterQual©.
- Demonstrate ability to interpret medical payer policy requirements.
- Strong ability to research evidence-based practices.
- Contact appropriate parties (internal and/or external) as needed for additional information to properly formulate and evaluate a clinical summary.
- Utilize computer programs and software to ensure assigned cases are tracked and monitored in an efficient and effective manner.
- Review and apply contract language as necessary to clinical summaries.
- Utilize payer administrative manuals to dispute denied claims.
Education and Experience
- Bachelor Degree preferred
- At least one year case management or similar appeal experience required
- Relevant education may substitute experience requirement
- State RN License required (Active/Inactive)
Parallon believes that organizations that continuously learn and improve will thrive. That’s why after more than a decade we remain 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 revenue cycle services.
We are a wholly owned subsidiary of HCA Healthcare, a comprehensive healthcare network where 265,000 people across more than 1,800 care facilities are all committed to creating a positive impact every day. It’s an organization that exists to give people healthier tomorrows. Our scale enables caregivers to deliver great outcomes for patients and gives colleagues unparalleled opportunities to learn and grow. Most importantly, as a part of HCA Healthcare we’re connected to something bigger, which means more resources, more solutions and more possibilities for everyone who walks through our doors. What matters most to our diverse and talented colleagues is giving people the absolute best healthcare possible. Every day, we seek to raise the bar higher, not just for ourselves, but for healthcare everywhere.
We are a family 270,000 strong! Our Talent Acquisition team is reviewing applications immediately. Highly qualified candidates will be promptly contacted by our hiring managers for interviews. Submit your resume today to join our community of caring!
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking URL blocked - click to apply.
For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.