Clinical Appeals Nurse Rn Wfh

Description

Introduction

Do you want to join an organization that invests in you as a(an) Clinical Appeals Nurse RN WFH? At Work from Home, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
• Colleague recognition program
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• 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 free telemedicine services and free AirMed medical transportation.
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Free counseling services and resources for emotional, physical and financial wellbeing
• 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.
• Consumer discounts through Abenity and Consumer Discounts

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

You contribute to our success. Every role has an impact on our patients’ lives and you have the opportunity to make a difference. We are looking for a dedicated Clinical Appeals Nurse RN WFH like you to be a part of our team.

Job Summary And Qualifications

Seeking a Clinical Appeals Nurse who will be 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

• Contact appropriate parties (internal and/or external) as needed for additional information to resolve the clinical appeal.
• Determine root cause of each denial and apply company specific coding for trending and analysis.
• Update the patient account record to identify actions taken on the account.
• Identify problem accounts/processes/trends and escalate as appropriate.
• Compose clinical appeal letters to send to payers for denial reconsiderations utilizing documentation, contract language, or voice recordings as applicable.
• Demonstrate the ability to interpret medical payer policy requirements.
• Present a concise medical summary within each appeal based on support from the medical record.
• Demonstrate understanding of use of all medical necessity software, including but not limited to InterQual.

What Qualifications You Will Need

• Strong ability to research evidence-based practices and is able to identify trends and process improvements.
• Currently licensed as a Registered Nurse (RN) in the state(s) of practice and/or has an active compact license, in accordance with law and regulation
• Associates Degree preferred
• At least 1 year of case management experience required
• Relevant education may substitute experience requirement

"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."

"Good people beget good people."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Clinical Appeals Nurse RN WFH opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!

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.