Clinical Appeals Team Lead

1 month ago

Nashville, Tennessee, United States HCA Healthcare Full time

Description

Introduction

Do you want to join an organization that invests in you as a Clinical Appeals Team Lead? At Parallon, 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

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.

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 Clinical Appeals Team Lead like you to be a part of our team.

Job Summary and Qualifications

Seeking a Clinical Appeals Team Lead who will be responsible for performing daily appeals follow-up, monitoring denials trends/issues and assisting the Clinical Appeals Manager with training of the appeals department. 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 now

What you will do in this role:

  • Provides introductory and ongoing training and education to Clinical Appeals staff to ensure that policies and procedures are followed.
  • Meets with the Manager regularly to effectively communicate and resolve issues, set and prioritize goals and improve processes.
  • Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards.
  • Maintains established departmental policies and procedures, objectives, patient and customer service policies.
  • Assists with payroll activities for team members(i.e., time cards, edit sheets).
  • Assists manager with development and implementation of project and department action plans.
  • Monitors insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reason.
  • Identifies coding or clinical documentation issues and work to correct the errors in a timely manner
  • Identifies problem accounts and escalates as appropriate
  • Updates the patient account record to identify actions taken on the account
  • Works with guarantors to secure payment on account balances denied for clinical reasons
  • Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"..
  • Performs other duties as assigned

What qualifications you will need:

  • Associate's Degree in Nursing required.
  • Prior supervisory experience preferred.
  • Minimum one year case management experience required.
  • Relevant education may substitute experience requirement.
  • 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 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 Clinical Appeals Team Lead 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.

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