Clinical Appeals Team Lead, RN/LPN in Orange Park, FL at Parallon

Date Posted: 6/12/2018

Job Snapshot

Job Description

This is a work from home opportunity. In order to be considered, you must be willing and able to work from home on a full time basis.


Job Summary – The Clinical Appeals Team Lead is responsible for performing daily appeals
follow-up, monitoring denial trends/issues and assisting the Clinical Appeals Manager with training
of the appeals department.

Supervisor – Clinical Appeals Manager

Duties (included but not limited to):
• Provides introductory and ongoing training and education to Clinical Appeals staff to
ensure that policies and procedures are followed
• Meets with the Manager regularly to effectively communicate and resolve issues, set and
prioritize goals and improve processes
• Assists with staff communication, providing updates, resolving issues, setting goals and
maintaining standards
• Maintains established departmental policies and procedures, objectives, patient and
customer service policies
• Assists with payroll activities for team members(i.e., time cards, edit sheets)
• Assists manager with development and implementation of project and department action
• Monitors insurance denials by running appropriate reports and contacting insurance
companies to resolve claims denied for clinical reasons
• Identifies coding or clinical documentation issues and work to correct the errors in a timely
• Identifies problem accounts and escalates as appropriate
• Updates the patient account record to identify actions taken on the account
• Works with guarantors to secure payment on account balances denied for clinical reasons
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value
• Performs other duties as assigned 

Job Requirements

• Organization - proactively prioritizes needs and effectively manages resources
• Communication - communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately.
• 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
• Leadership - guides individuals and groups toward desired outcome by providing training, advice and feedback to assist/support employees in achieving established performance standards
• Tactical execution - assist in monitoring operational processes and making recommendations for changes/adjustments as needed during the implementation or change to new products or processes
• Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
• Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes, have ability to work quickly and accurately in a fast-paced environment while managing multiple demands, ability to work both independently and collaboratively as a team player, adaptability, analytical and problem solving ability and attention to detail and 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

• Associate’s Degree in Nursing required
• Prior supervisory experience preferred

• Minimum one year case management experience required
• RN or LPN experience required

CERTIFICATE/LICENSE – Current State RN or LPN license required.