Nurse-Clinical Appeals

  • Company: Hospital Corporation of America
  • Location: Richmond, Virginia
  • Posted: December 01, 2017
  • Reference ID: 08648-142121
*WORK FROM HOME - Requirements*

  • ON-SITE Training REQUIRED in Richmond, VA
  • Internet Connectivity requirements - At a minimum :
- Cable or DSL (Digital Subscriber Line)
- Minimum Download Speed: 1 MB/S
- Minimum Upload Speed: 512 KB/S
- Minimum Latency: under 90ms
  • Please contact your internet service provider for verification of the specifications listed above.

Nurse - Clinical Appeals

This applicant must be an RN or LPN with current state licensure and must be able to accommodate a Monday-Friday work schedule, from 8:30AM to 5:00PM.

The Clinical Appeals Nurse will handle appeals requiring clinical input or interpretation as well as, monitor insurance denials.

Key responsibilities:
  • Run appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons
  • Review medical records and create Appeal letters to overturn a denial of service
  • Identify coding or clinical documentation issues and works to correct the errors in a timely manner
  • Update patient account records to identify action taken on the account
  • Work with guarantors/insurance companies to secure payment on account balances outstanding for clinical reasons

  • Associate's degree or higher

  • At least two years of Nursing experience preferred.
  • At least one year of case management or related required.
  • Experience using medical necessity criteria preferred .

CERTIFICATE/LICENSE - State of Virginia RN or LPN License required

Parallon is an Equal Opportunity Employer (EOE), minority/Female/Veteran/Disabled, offering a great work environment, challenging career opportunities, and competitive compensation.

Parallon is an affiliate of Hospital Corporation of America (HCA Holdings, Inc.) and is a leading provider of healthcare business and operational services. Parallon supports healthcare providers in the areas of revenue cycle (billing, collections, denial management), technology, patient registration, insurance verification, and health information management.

We offer free parking, training support, competitive salary and excellent benefits to include several insurance package options for Medical, Dental and Vision; Paid Time Off for vacation, sick leave and holidays, Employer-paid Short Term Disability, Company matching 401K and more!

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