Nurse Clinical Appeals - Richmond Shared Services Center in Richmond, VA at Parallon

Date Posted: 8/3/2018

Job Snapshot

Job Description

Nurse Clinical Appeals – Richmond Shared Services Center
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 areas of revenue cycle (billing, collections, and denial management), technology, patient registration, insurance verification, and health information management.
The Clinical Appeals Nurse will be responsible for providing clinical input and/or interpretation of insurance denials as well as monitor the denial process.   Must be an RN or LPN with current state licensure and must be able to accommodate a Full Time opportunity, working Monday through Friday, from 8:30AM to 5:00PM.
Duties (included but not limited to):
  • Run appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons
  • Review medical records and create Appeal letters to overturn a denial of service
  • Identify coding or clinical documentation issues and works to correct the errors in a timely manner
  • Update patient account records to identify action taken on the account
  • Work with guarantors/insurance companies to secure payment on account balances outstanding for clinical reasons

Job Requirements

  • Associate’s Degree or higher

  • At least two years of nursing experience preferred.
  • At least one year of case management or related required.
  • Experience using medical necessity criteria preferred.

 ****CERTIFICATE/LICENSE - State of Virginia RN or LPN License required
We offer a convenient location, free parking, training support, competitive compensation, and excellent benefits that include several insurance packages to choose from, paid time off for vacation, sick leave and holidays, company matching 401K.
Parallon is an Equal Opportunity Employer (EOE), minority/Female/Veteran/Disabled, offering a great work environment, challenging career opportunities, and competitive compensation.