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Payment Compliance Nurse
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Franklin, Tennessee |
About this job
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. We offer unmatched scale, infrastructure and access with more than 30 domestic and international facilities in the United States, the U.K., Mexico and China.
Job Summary – The Payment Compliance Nurse will review post write off denials to determine if accounts written off met medical necessity. Position requires individuals with ability to access and assimilate data, articulate a strong case, confidence, and strong persuasion skill set. Results oriented individual will be required to work through various options available to liquidate the most difficult high dollar denials. Candidate will demonstrate ability to review available documentation, clinical information and provide clinical expertise individual claims. Critical thinking skills are necessary, as well as ability to see trends that require escalation to the AVP. Responsible for bundling similar cases not resolved through the Corporate Payment Compliance unit and escalate to Dispute Resolution Team for legal action.
Duties (included but not limited to):
Analyzes hospital claims to provide clinical interpretation on post write off denials.
Resolves denied claims from various Payor products including HMO, PPO, Medicaid, Medicare and Workers' Compensation.
Articulates contract provisions to representatives from healthcare Payor companies and government agencies.
Write denial letters or justification on denied claims to appeal to payors.
Identifies and communicates contract interpretation issues and language discrepancies to leadership as appropriate.
Identifies Payor company trends and communicates trends to supervisor for further action/escalation.
Serves as a clinical resource to the Corporate Payment Compliance team.
Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”
Other duties as assigned
Associate’s Degree required. Bachelor’s degree preferred. Master’s degree preferred. Two years of utilization review experience preferred. Current State RN or LPN License required.
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. We offer unmatched scale, infrastructure and access with more than 30 domestic and international facilities in the United States, the U.K., Mexico and China.
Job Summary – The Payment Compliance Nurse will review post write off denials to determine if accounts written off met medical necessity. Position requires individuals with ability to access and assimilate data, articulate a strong case, confidence, and strong persuasion skill set. Results oriented individual will be required to work through various options available to liquidate the most difficult high dollar denials. Candidate will demonstrate ability to review available documentation, clinical information and provide clinical expertise individual claims. Critical thinking skills are necessary, as well as ability to see trends that require escalation to the AVP. Responsible for bundling similar cases not resolved through the Corporate Payment Compliance unit and escalate to Dispute Resolution Team for legal action.
Duties (included but not limited to):
Analyzes hospital claims to provide clinical interpretation on post write off denials.
Resolves denied claims from various Payor products including HMO, PPO, Medicaid, Medicare and Workers' Compensation.
Articulates contract provisions to representatives from healthcare Payor companies and government agencies.
Write denial letters or justification on denied claims to appeal to payors.
Identifies and communicates contract interpretation issues and language discrepancies to leadership as appropriate.
Identifies Payor company trends and communicates trends to supervisor for further action/escalation.
Serves as a clinical resource to the Corporate Payment Compliance team.
Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”
Other duties as assigned
Associate’s Degree required. Bachelor’s degree preferred. Master’s degree preferred. Two years of utilization review experience preferred. Current State RN or LPN License required.
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