Clinical Appeals Nurse  in Nashville, Tennessee, United States
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Parallon

Clinical Appeals Nurse

New
Nashville, TN, United States
Full-time • Work From Home
Case Management   Job ID: 08942-203455
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Description

SHIFT: Work From Home
SCHEDULE: Full-time


Are you looking for a work environment where diversity and inclusion thrive? Submit your application with HCA Healthcare today and find out what it truly means to be a part of a team.

We are committed to providing our colleagues with the support they need. We offer an array of medical, dental, and vision packages as well as several add-on perks to make your benefits package truly customizable to you. Some of our unique benefits we offer part-time and full-time employees include:
 

  • Student Loan Repayment
  • Tuition Reimbursement/Assistance Programs
  • 401k (100% annual match – 3%-9% of pay based on years of service)
  • Identity Theft Protection discounts
  • Auto, Home, and Life Insurance options
  • Adoption Assistance
  • Employee Stock Purchase Program (ESPP)

 

We value your contributions. Our employee recognition programs encourage our teams to raise the bar. Come be a part of the change!  

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

In this role you will:

  • 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
  • Demonstrate a strong ability to research evidencebased 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 companyspecific 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
  • Complete all required annual training 

Qualifications

  • Associate’s degree preferred
  • At least 1 year of case management experience required
  • Relevant education may substitute experience requirement

Certificate/License – must be currently licensed as a registered nurse (RN) or (LPN) in the state(s) of practice and/or has an active compact license, in accordance with law and regulation.  

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 dedicated to ensuring our patients have the best experience even after they leave our facilities.
 

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 actively reviewing applications. Highly qualified candidates will be promptly contacted for interviews. Submit your application and help us raise the bar in patient care!

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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Additional Job Applicant Resources

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

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