Job Information
HCA Healthcare Clinical Appeals Team Lead Nurse in Nashville, Tennessee
Description
Introduction
Are 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 Clinical Appeals Team Lead Nurse today with Parallon.
Benefits
Parallon, 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 free 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.
Free counseling services and resources for emotional, physical and financial wellbeing
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
Employee Stock Purchase Plan with 10% off HCA Healthcare stock
Family support through fertility and family building benefits with Progyny and adoption assistance.
Referral services for child, elder and pet care, home and auto repair, event planning and more
Consumer discounts through Abenity and Consumer Discounts
Retirement readiness, rollover assistance 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)
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards)
Note: Eligibility for benefits may vary by location.
Come join our team as a Clinical Appeals Team Lead Nurse. 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 Qualifications
The Compliance Nurse Team Lead is responsible for providing clinical input or interpretation for denials that have remained unresolved or have been escalated by the Shared Service Center (SSC) operations pre-established protocols. This position will be critical in supporting the dispute resolution strategy focused on denial cash conversion.Tracking large case volumes efficiently and effectively, with technology, while providing the highest levels of customer service and attention to details is required. The Compliance Nurse TL will be assisting the Director of Payer Analysis with training, education and performing on-going quality assessments of the Dispute Resolution Compliance Clinical team.
What you will do in this role:
Provides introductory and ongoing training and education to Dispute Resolution Compliance Nurse staff to ensure that policies and procedures are followed
Meets with the Director regularly to effectively communicate and resolve issues, set and prioritize goals and improve processes
Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards
Assists Director with development and implementation of project and department action plans
Perform on-going quality assessments of the clinical staff in the Dispute Resolution Department to ensure accurate completion of clinical reviews
Act as a clinical resource to the Dispute Resolution Clinical team for complicated cases
Identifies clinical documentation issues and work to correct the errors in a timely manner
Identifies problem accounts and escalates as appropriate
Demonstrate understanding of use of all Medical Necessity software, including but not limited to InterQual©.
Demonstrate ability to interpret medical payer policy requirements
Strong ability to research evidence-based practices
Contact appropriate parties (internal and/or external) as needed for additional information to properly formulate and evaluate a clinical summary.
Review and apply contract language as necessary to clinical summaries
Utilize payer administrative manuals to dispute denied claims
What qualifications you will need:
Associate’s Degree in Nursing required
Prior supervisory experience preferred
Minimum one year case management experience required
Relevant education may substitute experience requirement
Currently licensed as a registered nurse (RN) or in the state(s) of practice and/or has an active compact license, in accordance with law and regulation
Parallon (https://parallon.com/) 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 Clinical Appeals Team Lead Nurse 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.
HCA Healthcare
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