HCA, Hospital Corporation of America Manager Clinical Appeals in Nashville, Tennessee
Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
GENERAL SUMMARY OF DUTIES- The Clinical Appeals Manager manages all activities related to monitoring and appealing denials received from Third Party Payors.
DUTIES INCLUDE BUT ARE NOT LIMITED TO: • Manage daily activities related to PAS Clinical Appeals function, ensuring processes are performed efficiently and effectively • Analyze trends in insurance denials and work with insurance companies to resolve underlying reasons for denials • Manage recurring coding or clinical documentation issues and correct the underlying causes for errors. • Perform Q/A for Clinical Appeals function • Screen, interview, and hire new employees • Arrange for training of new employees • Review each staff member’s productivity on a monthly basis and performing annual evaluations • Counsel staff with disciplinary and productivity issues • Work as a liaison between the Clinical Appeals staff and other Patient Account Services staff • Resolve issues escalated by Clinical Appeals staff • Conduct monthly staff meetings • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement” • Other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES • Organization - proactively prioritizes needs and effectively manages resources • Communication - communicates clearly and concisely • Leadership - guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services • Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations • Tactical execution - oversees the development, deployment and direction of complex programs and processes • Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems • PC skills - demonstrates proficiency in Microsoft Office applications and others as required • Financial management - applies tools and processes to successfully manage to budget
EDUCATION • High School Diploma or GED required. Bachelor’s Degree preferred. • Equivalent work experience may substitute degree requirement
EXPERIENCE • Minimum 4 years cashiering experience required • Minimum 2 years supervisory experience required
PHYSICAL DEMANDS/WORKING CONDITIONS- Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain
Title: Manager Clinical Appeals
Location: Tennessee-Nashville-PAS - Nashville
Requisition ID: 08942-125520