Clinical Appeals Nurse - As Needed in Nashville, TN at Parallon

Date Posted: 5/4/2018

Job Snapshot

Job Description

JOB TITLE: Clinical Appeals Specialist
GENERAL SUMMARY OF DUTIES - Handles appeals requiring clinical input or interpretation
SUPERVISOR - Logging Manager
SUPERVISES - N/A
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
 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

Job Requirements

 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
EDUCATION
 Associate’s Degree preferred
EXPERIENCE
 At least one year case management experience required
 Relevant education may substitute experience requirement
CERTIFICATE/LICENSE - Current State RN or LPN License

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