Compliance Nurse in Nashville, Tennessee, United States
Join our Talent Network
Skip to main content

Compliance Nurse

Work from Home
Nashville, TN, United States
Full-time • Work From Home
Case Management   Job ID: 518430
Save Job Unsave Job

Apply


Description

Introduction

Do you want to join an organization that invests in you as a(an) Compliance Nurse? At Work from Home, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

Benefits

Work from Home, 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 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.
  • Fertility and family building benefits through Progyny
  • Free counseling services and resources for emotional, physical and financial wellbeing
  • Family support, including adoption assistance, child and elder care resources and consumer discounts
  • 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  • Employee Stock Purchase Plan
  • Retirement readiness and rollover 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)

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated Compliance Nurse like you to be a part of our team.

Job Summary and Qualifications

The Compliance 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.

What you will do in this role:

  • 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.
  • Maintain and apply understanding of federal, state and local rules and regulations impacting denials.
  • Maintain and apply understanding of HCA / Parallon policies and procedures and work protocols impacting denials.

What qualifications you will need:

  • Bachelor Degree preferred

  • At least one year case management or similar appeal experience required
  • Relevant education may substitute experience requirement
  • State RN or LPN License required (Active/Inactive)

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.

"Good people beget good people."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Compliance Nurse opening. Qualified candidates will be contacted 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.

Apply

Save Job Unsave Job

Details

Case Management
Work from Home
Full-time • Work From Home

COVID-19 Vaccination

In compliance with the emergency regulation issued by the Centers for Medicare & Medicaid Services (CMS) dated November 4, 2021, and company policy, this role MAY require you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations, or to have applied for a medical or religious exemption (including booster for California). (For further clarification, please ask your recruiter.)

About HCA Healthcare

What matters most to our diverse and talented colleagues is giving people the absolute best healthcare in the most compassionate way possible.

Learn more about HCA Healthcare chevron_right

Similar Jobs

For questions about your job application or this site, please contact;
HCAhrAnswers at 1-844-422-5627 option 1.

Get job notifications based
on your interests

Join our Talent Network