Clinical Appeals Specialist Virtual

Company: HCA Healthcare
Location: Hendersonville
Posted on: January 24, 2023

Job Description:

Description IntroductionAre you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Recovery Audit Contractor Certified Specialist today with Parallon.BenefitsParallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Fertility and family building benefits through Progyny
  
  
• Free counseling services and resources for emotional, physical and financial wellbeing
  
  
• Family support, including adoption assistance, child and elder care resources and consumer discounts
  
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
  
• Employee Stock Purchase Plan
  
  
• Retirement readiness and rollover services and preferred banking partnerships
  
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
  
• Colleague recognition program
  
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  
  Learn more about Employee BenefitsNote: Eligibility for benefits may vary by location.
  
  Come join our team as a(an) Recovery Audit Contractor Certified Specialist. We care for our community! Just last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations. Apply Today!Job Summary and QualificationsSeeking a Recovery Audit Contractor Certified Specialist, who is responsible for handling appeals requiring clinical input or interpretation. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you. We want you to apply today!What you will do in this role:
  • Review medical records and other documentation to compose RAC appeal letter with concise medical summary based on support from the medical record and prepare RAC appeal package accordingly
  • Demonstrate ability to interpret CMS policy requirements
  • Strong ability to research evidence-based practices
  • Identify problem claims and appeals and escalate as appropriate
  • Update the RRT and any other systems (Artiva, SSD Web Tools) to identify actions taken on the account What qualifications you will need:
    • Currently licensed as an LPN or RN in the state(s) of practice and/or has an active compact license, in accordance with law and regulation
    • High School diploma or GED required; Associate's Degree preferred
    • 1 year of Case Manager, Insurance utilization and/or hospital experience preferred
    • Relevant education may substitute experience requirement
    • InterQual knowledge required Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.
      HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
      ""The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr.
      
      HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Recovery Audit Contractor Certified Specialist opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
      This position is incentive eligible.

Keywords: HCA Healthcare, Hendersonville , Clinical Appeals Specialist Virtual, Healthcare , Hendersonville, Tennessee