Clinical Appeals Nurse RN

Description Work from home positions require you to live within 60 miles of an HCA Hospital Work from home positions require employees to have wired cable or fiber with 25 MBS download and 15 MBS Upload Introduction: Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: Clinical Appeals Nurse RN Parallon

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. We are seeking a Clinical Appeals Nurse RN for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply! Job Summary and Qualifications The Clinical Appeals Nurse is responsible for handling appeals requiring clinical input or interpretation. In this role you will:

• Compose clinical appeal letters to send to payers for denial considerations 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 the ability to interpret medical payer policy requirements.
• Contact appropriate parties (internal and/or external) as needed for additional information to resolve 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.

What Qualifications you will need:

• Associates Degree preferred.
• At least 1 year of case management experience required.
• Relevant education may substitute experience requirement.
• Strong ability to research evidence-based practices and is able to identify trends and process improvements.
• Work from home positions require you to live within a 60 miles of an HCA Hospital
• Work from home positions require employees to have wired cable or fiber with 25 MBS download and 15 MBS Upload

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. "There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you find this opportunity compelling, we encourage you to apply for our Clinical Appeals Nurse RN opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Apply tot his job Apply To this Job