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Clinical Appeals Nurse WFH in Richmond at Parallon

Date Posted: 5/9/2019

Job Snapshot

Job Description

Clinical Appeals Nurse WFH
 
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:
The Clinical Appeals Nurse is responsible for handling appeals requiring clinical input or interpretation.
 
This is a Full-Time work from home position, Monday through Friday, 8:30am - 5:00pm.
 
 Duties (included but not limited to):
 
  • Compose clinical appeal letters to send to payers for denial reconsiderations 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 ability to interpret medical payer policy requirements
  • Strong ability to research evidence-based practices
  • Contact appropriate parties (internal and/or external) as needed for additional information to properly formulate 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
  • Identify problem accounts/processes/trends and escalate as appropriate

 
Education:
  • Associate’s Degree preferred
     

Certificate/Lincense:
  • State RN or LPN License required (Active/Inactive)
     

Experience:
  • At least one year case management experience required
  • Relevant education may substitute experience requirement

 
We offer free parking, training support, competitive salary and excellent benefits to include several insurance package options for Medical, Dental and Vision; Paid Time Off for vacation, sick leave and holidays, Employer-paid Short Term Disability, Company matching 401K and more!

Parallon is an Equal Opportunity Employer (EOE), minority/ female/ veteran/ disabled, offering a great work environment, challenging career opportunities, and competitive compensation.
 
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