Prebill Denials RN, Virtual in Nashville, Tennessee, United States
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Prebill Denials RN, Virtual

Texas Pre-Bill Denial
Nashville, TN, United States
Full-time • Work From Home
Case Management   Job ID: 27090-209402
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Description

SHIFT: Work From Home
SCHEDULE: Full-time


Schedule: Flexible Start Times | Office Hours 7am-5:30pm Central 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 Prebill Denials Nurse, you will review post discharge, prebill accounts that do not have an authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that require clinical expertise. Communicates with third party payors to resolve discrepancies prior to billing.

In this role you will:

  • Work post discharge, prebill accounts efficiently and effectively on a daily basis to resolve accounts with “no auth numbers, ALOS vs. authorized days or other discrepancies
  • Evaluates clinical documentation on multiple patient accounts and escalates issues through the established channels  
  • Perform accurate and timely documentation of all review activities based on policy and procedure
  • Demonstrates a working knowledge of managed care agreements based on available resources which may include and not be limited to payer UM Manual, policy and procedure, facility contract information. Escalates variations timely.
  • Work assigned accounts in eRequest to resolve outstanding issues
  • Report insurance denial trends identified during daily operational assignments
  • Contact facilities, physicians’ offices and/or insurance companies to resolve denials/appeals if needed
  • Demonstrates knowledge of regulatory requirements, Ethics and Compliance policies, and quality initiatives; monitors selfcompliance and implements process changes to ensure compliance to such regulations and quality initiatives.
  • Assess CPT code(s) for outpatient accounts that require authorization when accounts have not been coded
  • Communicates effectively and professionally with physicians, hospital staff, and outside agencies

Qualifications

  • Registered Nursing degree and current licensure.
  • Healthcare experience in an acute care hospital. Utilization review, appeals, denials, managed care contracting experience preferred.

Certificate/License

  • 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 

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
Texas Pre-Bill Denial
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 have received the first dose of a two-dose COVID-19 vaccination series (or a one-dose COVID-19 vaccination) to meet CMS requirements, 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.

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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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