Clinical Appeals Nurse in Nashville, Tennessee, United States
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Parallon

Clinical Appeals Nurse

Nashville, TN, United States
Full-time • Work From Home
Case Management   Job ID: 26875-193331
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Description

SHIFT: Work From Home
SCHEDULE: Full-time


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.

 

At HCA Healthcare, you have options. You can choose from a variety of benefits to create a customizable plan. You have the ability to enroll in several medical coverage plans including vision and dental. You can even select additional a la carte benefits to meet all your needs. Enroll in our Employee Stock Purchase Plan (ESPP), 401k, flex spending accounts for medical and childcare needs, and participate in our tuition reimbursement.

 

HCA Healthcare is dedicated to the growth and development of our colleagues. We will provide you the tools and resources you need to succeed in our organization. We are currently looking for an ambitious Clinical Appeals Nurse to help us reach our goals. Unlock your potential here!

 

As a Clinical Appeals Nurse, you will be responsible for handling appeals requiring clinical input or interpretation.

 

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 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 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


Qualifications

EDUCATION

Associate’s Degree preferred

 

EXPERIENCE

• At least one year case management experience required

• Relevant education may substitute experience requirement

 

CERTIFICATE/LICENSE - State RN or LPN License required (Active/Inactive)

 

 

Parallon is an industry leader in revenue cycle services. We partner with over 650 hospitals and 2,400 physician practices nation-wide. Our parent company, HCA Healthcare has been consistently named a World’s Most Ethical Company by Ethisphere and is ranked in the Fortune 100.

 

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.


Notice

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 here.

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

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Details

Case Management
Parallon
Full-time • Work From Home

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.

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

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