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Clinical Appeals Specialist RN (Work from Home) - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Irving, Texas |
About this job
Parallon Business Solutions includes financial services, revenue operations, patient account services, health information management, and human resources for our non-hospital lines of business, allowing patient care delivery partners to direct all of their attention and commitment to quality patient care.
Job Summary - Handles appeals requiring clinical input or interpretation
Key Responsibilities
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
Knowledge, Skills & Abilities
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/LVN License
Parallon Business Solutions is an equal opportunity employer, offering a great work environment, challenging career
Job Summary - Handles appeals requiring clinical input or interpretation
Key Responsibilities
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
Knowledge, Skills & Abilities
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/LVN License
Parallon Business Solutions is an equal opportunity employer, offering a great work environment, challenging career
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