HCA, Hospital Corporation of America Clinical Appeals Specialist Registered Nurse in Nashville, Tennessee

JOB TITLE: Clinical Appeals Specialist GENERAL SUMMARY OF DUTIES - Handles appeals requiring clinical input or interpretation SUPERVISOR - Logging Manager SUPERVISES - N/A DUTIES INCLUDE BUT ARE NOT LIMITED TO:  Monitor insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons  Identify coding or clinical documentation issues and work to correct the errors in a timely manner.  Identify problem accounts and escalates as appropriate  Update the patient account record to identify actions taken on the account.  Work with guarantors to secure payment on account balances outstanding for clinical reasons  Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”  Other duties as assigned

 Communication - communicates clearly and concisely, verbally and in writing  Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations  Interpersonal skills - able to work effectively with other employees, patients and external parties  PC skills - demonstrates proficiency in Microsoft Office applications and others as required  Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems  Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately  Clinical skills - ability to read and interpret medical records EDUCATION  Associate’s Degree preferred EXPERIENCE  At least one year case management experience required  Relevant education may substitute experience requirement CERTIFICATE/LICENSE - Current State RN or LPN License

Title: Clinical Appeals Specialist Registered Nurse

Location: Tennessee-Nashville-PAS - Nashville

Requisition ID: 08942-125355