Clinical Appeals Nurse in Richmond at Parallon

Date Posted: 11/5/2018

Job Snapshot

Job Description

Clinical Appeals Nurse
 
Parallon is an affiliate of Hospital Corporation of America (HCA Holdings, Inc.) and is a leading provider of healthcare business and operational services. Parallon supports healthcare providers in the area of revenue cycle (billing, collections, denial management), technology, patient registration, insurance verification and health information management.
 
Job Summary:
The Clinical Appeals Nurse is responsible for handling appeals requiring clinical input or interpretation.
 
 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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