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Director of Appeals

Company: Parallon
Location: Hendersonville
Posted on: October 8, 2019

Job Description:

Description SHIFT: No Weekends

SCHEDULE: Full-time

Do you want to be a part of afamily and not just another employee? Are you looking for a work environmentwhere diversity and inclusion thrive? Submit your application today and findout what it truly means to be a part of a team.--At HCA Healthcare, you haveoptions. You can choose from a variety of benefits to create a customizableplan. You have the ability to enroll in several medical coverage plansincluding vision and dental. You can even select additional a la carte benefitsto meet all your needs. Enroll in our Employee Stock Purchase Plan (ESPP),401k, flex spending accounts for medical and childcare needs, and participatein our tuition reimbursement and student loan repayment programs. --HCA Healthcare is dedicated tothe growth and development of our colleagues. We will provide you the tools andresources you need to succeed in our organization. We are currently looking foran ambitious Appeals Director to help us reach our goals. Unlock your potentialhere!--As an AppealsDirector, youwill be responsible for daily operations of allfunctions and oversight of all activities related to monitoring and appealingdenials received from Third Party Payers. The Director will serve as a keyliaison between the SSC CFO, Division CFOs, Case Management, PDU Director,Appeals Managers, Facility CFOs, PADs, and other team members within theorganization regarding denials and appeals. ----What you will do in thisrole:----- Oversee the activitiesand management related to denial inventory, ensuring processes are performedefficiently, effectively and accurately within all established operational andSOX guidelines. --- Establish controls andreview mechanisms for SSC policies and procedures. --- Ensure timely submissionof appeals and liquidation of denials inventory. --- Provide support andguidance related to the Denials Management Action Teams (DMAT) --- Monitor, trend andcommunicate with SSC Leadership, Case Management, Denials Managers, andFacility Leadership regarding denial trends, new denials and final write offdenials identified via EDW, Visual Insight Dashboard, Vista, and other denialstools reports. --- Demonstrate strongcommitment to stakeholder relationships by taking ownership of issues andfacilitating effective outcomes in a timely manner. --- Understand andcommunicate contract specific issues related to the resolution of disputedpayments, discount and allowance calculations for a variety of payers such asMedicare, Medicaid, HMOs, PPOs, IPAs, employers, etc. --- Oversee management ofpersonnel, providing recommendations for hiring, promotion, salary adjustmentand personnel action where appropriate. --- Follow escalationprotocols to include Attorney, Corporate Dispute Resolution, Strategic Pricingand Analytics, and Corporate Payment Compliance. --- Participate in JointOperating Committees (JOC) with payers, ensuring partnership in inventoryresolution. --- Oversee all reconciliation activities for inventory. --- Proactively ensuretraining of all employees, including identification and communication of anyoperational gaps identified in day to day activities. --- Monitor trends andcommunicate significant shifts in market or operating conditions to SSC andfacility leadership. --- Identify and implementprocess improvement initiatives that reduce cost and improve performance.-- Qualifications --EDUCATION Bachelor---s Degree in Businessor related field required.-- If a desiredapplicant does not have a Bachelor's Degree the requirement can be waived IFthey are currently in a Bachelor Degree program.---- --EXPERIENCE Minimum 5 years healthcaremanagement experience with three of these years in the related area for theposition.-- Relevant education maysubstitute experience requirement with SSC Executive approval. ------Parallonis an industry leader in revenuecycle services. We partner with over 650 hospitals and 2,400 physicianpractices nation-wide. Our parent company, HCA Healthcare has been consistentlynamed a World---s Most Ethical Companyby Ethisphere and is ranked in the Fortune 100.--We are a family 270,000 strong!Our Talent Acquisition team is reviewing applications immediately. Highlyqualified candidates will be promptly contacted by our hiring managers forinterviews. Submit your resume today to join our community of caring! --We are anequal opportunity employer and value diversity at our company. We do notdiscriminate on the basis of race, religion, color, national origin, gender,sexual orientation, age, marital status, veteran status, or disability status.

Company Description:

HCA Healthcare is a collaborative healthcare network, driven by physicians, nurses and colleagues helping each other champion the practice of medicine to give people a healthier tomorrow. With a comprehensive network of more than 270,000 people across approximately 1,800 care facilities, our scale enables us to deliver great outcomes for our patients, provide superior nursing care and be a preferred place for physicians to practice medicine. We never stop in our pursuit of insights and care advances based on the knowledge and data we gain from approximately 30 million patient encounters a year. Every day, we raise the bar to improve the way healthcare is delivered, not just in our facilities, but everywhere. We---re committed to improving more lives in more ways, and above all else, we are committed to the care and improvement of human life.

Keywords: Parallon, Hendersonville , Director of Appeals, Executive , Hendersonville, Tennessee

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