Appeals Director in Nashville at Parallon

Date Posted: 10/30/2018

Job Snapshot

  • Employee Type:
  • Location:
  • Job Type:
  • Experience:
    At least 5 year(s)
  • Date Posted:

Job Description

Parallon, a leading health care company, is offering a great opportunity. We are looking for a dynamic candidate to be part of our team.  We offer excellent relocation and benefit packages, including 401(K), bonus potential, tuition reimbursement, medical and dental plans, flexible spending plans, long-term/short -term disability, and generous paid time off!

The Appeals Director is responsible for daily operations of all functions and oversight of all activities related to monitoring and appealing denials received from Third Party Payers. The Director will serve as a key liaison between the Shared Service Center (SSC) CFO, Division CFOs, Case Management, PDU Director, Appeals Managers, Facility CFOs, Patient Access Directors, and other team members within the organization regarding denials and appeals. 

Duties (included but not limited to): 
• Oversee the activities and management related to denial inventory, ensuring processes are performed efficiently, effectively and accurately within all established operational and SOX guidelines. 
• Establish controls and review mechanisms for SSC policies and procedures. 
• Ensure timely submission of appeals and liquidation of denials inventory. 
• Provide support and guidance related to the Denials Management Action Teams (DMAT) 
• Monitor, trend and communicate with SSC Leadership, Case Management, Denials Managers, and Facility Leadership regarding denial trends, new denials and final write off denials identified via EDW, Visual Insight Dashboard, Vista, and other denials tools reports. 
• Demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner. 
• Understand and communicate contract specific issues related to the resolution of disputed payments, discount and allowance calculations for a variety of payers such as Medicare, Medicaid, HMOs, PPOs, IPAs, employers, etc. 
• Follow escalation protocols to include Attorney, Corporate Dispute Resolution, Strategic Pricing and Analytics, and Corporate Payment Compliance. 
• Participate in Joint Operating Committees (JOC) with payers, ensuring partnership in inventory resolution.
• Oversee all reconciliation activities for inventory. 
• Monitor trends and communicate significant shifts in market or operating conditions to SSC and facility leadership. 
• Identify and implement process improvement initiatives that reduce cost and improve performance. 

Job Requirements

We are in need of an experienced Appeals Director for our Shared Service Center in Nashville. You will be part of the team managing appeals for our external clients. We offer many opportunities for career growth. You need the following to be our top candidate:

  • Bachelor’s Degree in Business or related field required. 
  • Minimum 5 years' healthcare management experience with three of these years in the related area for the position.
  • An understanding of healthcare, including knowledge of healthcare terms and accounts receivable processes. 
  • Analytical review skills and the ability to make decisions based on analysis.