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Senior Appeals Analyst in San Antonio at Parallon

Date Posted: 5/16/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    San Antonio
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    5/16/2019

Job Description

Parallon believes that organizations that continuously learn and improve will thrive. That’s why after more than a decade we remain dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry’s leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services.
 
Job Summary - Researches and Resolves High Dollar Technical and Top Dollar Clinical Appeals through concise understanding of Payer Contract Language and Clinical or Technical justification. Position requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case, confidence, and strong persuasion skill set.  Results oriented individual will be required to work through various options available to liquidate the most difficult top dollar appeals. Candidate will demonstrate ability to grow strategic payer relationships and obtain understanding of payer system to navigate through the appeals process. Critical thinking skills are necessary, as well as ability to see trends that require escalation to the Payment Compliance Director.  Responsible for bundling similar cases not resolved through the standard Payment Compliance process and escalate to Dispute Resolution Team for legal action.
 
**This is a work from home position**
  
Duties (included but not limited to):
  • Review technical and clinical denial arguments for reconsideration on top dollar accounts, including both written and telephonically through resolution process.
  • Identify coding or clinical documentation issues and work to correct the errors in a timely manner.
  • Identify contract protection that can be leveraged to overturn denials.
  • Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument.
  • Identify problem accounts/processes/trends and escalate as appropriate.
  • Utilize effective documentation standards that support a strong historical record of actions taken on the account.
  • Identifies and communicates contract interpretation issues and language discrepancies to leadership as appropriate.
  • Identifies Payer company trends and communicates trends to supervisor for further action/escalation.
  • Serves as a subject matter expert in payer appeals resolution process.
  • Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”
  • Other duties as assigned

Job Requirements



KNOWLEDGE, SKILLS & ABILITIES

  • Communication - communicates clearly and concisely, verbally and in writing.
  • Persistence – comfortable pursuing, rebutting and escalating issues as appropriate. 
  • Goal-oriented – holds him/herself accountable to achieving shared and personal goals. 
  • 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 high proficiency in Microsoft Office applications and others as required.
  • Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems.
  • Mathematical skills - able to perform advanced mathematical calculations and balance and reconcile figures
  • Writing skills –advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately.



EDUCATION

  • Bachelor’s degree required. 
  • Master’s degree preferred. 



EXPERIENCE

  • Two years of related experience.   

Parallon/HCA is an equal opportunity workforce and no one shall discriminate against any individual with regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity or expression, genetic information or veteran status with respect to any offer, or term or condition, of employment. We make reasonable accommodations to the known physical and mental limitations of qualified individuals with disabilities.
 

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