Clinical Appeals Nurse

Description

Introduction

Do you have the career opportunities as a Clinical Appeals Nurse you want with your current employer? We have an exciting opportunity for you to join Parallon which is part of the nation's leading provider of healthcare services, HCA Healthcare.

Benefits

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
  
  

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a Clinical Appeals Nurse where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Job Summary And Qualifications

Seeking a Clinical Appeals Nurse who will be responsible for handling appeals requiring clinical input or interpretation. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you. We want you to apply today!

What you will do in this role:

• Compose clinical appeal letters to send to payers for denial reconsiderations utilizing documentation, contract language, or voice recordings as applicable.
• Present a concise medical summary within each appeal based on support from the medical record.
• Demonstrate understanding of use of all medical necessity software, including but not limited to InterQual.
• Demonstrate the ability to interpret medical payer policy requirements.
• Contact appropriate parties (internal and/or external) as needed for additional information to resolve the clinical appeal.
• Determine root cause of each denial and apply company specific coding for trending and analysis.
• Update the patient account record to identify actions taken on the account.
• Identify problem accounts/processes/trends and escalate as appropriate.
  
  

What qualifications you will need:

• Currently licensed as a Registered Nurse (RN) in the state(s) of practice and/or has an active compact license, in accordance with law and regulation
• Associates Degree preferred
• At least 1 year of case management experience required
• Relevant education may substitute experience requirement
• Strong ability to research evidence-based practices and is able to identify trends and process improvements.
  
  

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Clinical Appeals Nurse opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.