HCA, Hospital Corporation of America Clinical Appeals Specialist (RN/LVN) in Irving, Texas

Parallon Business Solutions includes financial services, revenue operations, patient account services, health information management, and human resources for our non-hospital lines of business, allowing patient care delivery partners to direct all of their attention and commitment to quality patient care.

Job Summary- Handles appeals requiring clinical input or interpretation

Key Responsibilities * Monitor insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons * Identify coding or clinical documentation issues and work to correct the errors in a timely manner * Identify problem accounts and escalates as appropriate * Update the patient account record to identify actions taken on the account * Work with guarantors to secure payment on account balances outstanding for clinical reasons * Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement" * Other duties as assigned

Knowledge, Skills & Abilities * Communication - communicates clearly and concisely, verbally and in writing * Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations * Interpersonal skills - able to work effectively with other employees, patients and external parties * PC skills - demonstrates proficiency in Microsoft Office applications and others as required * Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems * Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately * Clinical skills - ability to read and interpret medical records


Associate's Degree preferred

EXPERIENCE * At least one year case management experience required * Relevant education may substitute experience requirement


Parallon Business Solutions is an equal opportunity employer, offering a great work environment, challenging career

Title: Clinical Appeals Specialist (RN/LVN)

Location: Texas-Irving-PAS - Dallas

Requisition ID: 08950-114455