***This is a work from home position***
Job Summary - The Appeals Team Lead is responsible for performing daily appeals follow-up, monitoring denial trends/issues and assisting the Appeals Manager with training of the appeals department.
Supervisor - Appeals Manager
Supervises - N/A
Duties (included but not limited to):
• Provides introductory and ongoing training and education to all Appeals staff to ensure that policies and procedures are followed
• Meets with the Manager regularly to effectively communicate and resolve issues, set and prioritize goals and improve processes
• Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards, including performing QA reviews for staff
• Maintains established departmental policies and procedures, objectives, patient and customer service policies
• Assists with payroll activities for team members (i.e. edit sheets)
• Assists manager with development and implementation of project and department action plans
• Monitors insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons
• Identifies coding or clinical documentation issues and work to correct the errors in a timely manner
• Identifies problem accounts and/or trended issues and escalates as appropriate
• Updates the patient account record to identify actions taken on the account
• Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
• Performs other duties as assigned
High School diploma or GED required.
• At least one year of related experience required.
CERTIFICATE/LICENSE - N/A
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom