Manager Clinical Appeals in San Antonio at Parallon

Date Posted: 10/19/2018

Job Snapshot

  • Employee Type:
  • Location:
    San Antonio
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

 Parallon is one of the country’s largest premier revenue cycle partners, with more than 15,800 employees serving 600 hospitals and 3,000 physician practices. Annually, we collect more than $41 billion and interact with 37 million patients. Our track record of results is among the best in the industry.  We serve hospitals, physician practices and healthcare systems by bringing deep operational knowledge and tailored revenue cycle solutions so that providers can focus on fulfilling their mission.
Appeals Manager
Job Summary The Appeals Manager is responsible for managing all activities related to monitoring and appealing denials received from Third Party Payers.
Supervisor – Appeals Director
Supervises – Appeals Specialists and Team Leads
Duties (included but not limited to):  
•       Manage daily activities and inventory related to SSC Appeals function, ensuring processes are performed accurately, efficiently and effectively within all established operational and SOX guidelines.
•       Analyze trends in insurance denials and work with insurance companies to resolve underlying reasons for denials
•       Manage recurring coding or clinical documentation issues and correct the underlying causes for errors.
•       Coordinate with all necessary departments related to contract issues.
•       Perform QA for all processes within Appeals
•       Screen, interview, and hire new employees
•       Arrange for training of new employees
•       Review each staff member’s productivity on a monthly basis and performing annual evaluations
•       Counsel staff with disciplinary and productivity issues
•       Work as a liaison between the Appeals staff and other SSC staff
•       Resolve issues escalated by Appeals staff
•       Conduct monthly staff meetings
•       Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
•       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. The ability to communicate with staff, Parallon Management, Division and Group Executives  
•      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 outcomes, setting high performance standards and delivering leading quality services
•      Tactical execution - oversees the development, deployment and direction of complex programs and processes
•      Project Management - assesses work activities and allocates resources appropriately
•      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.


Bachelor’s Degree in Business or related field required. 


Minimum three years’ experience in related area with two of these years being healthcare management experience OR completion of the Parallon Manager Trainee Program.
Parallon/HCA is an equal opportunity workforce and no one shall discriminate against any individual with regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity or expression, genetic information or veteran status with respect to any offer, or term or condition, of employment. We make reasonable accommodations to the known physical and mental limitations of qualified individuals with disabilities.


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