INTRODUCTION

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below:Clinical Denials Coding Review SpecialistParallon.

NOTE: ELIGIBILITY FOR BENEFITS MAY VARY BY LOCATION.

We are seeking a Clinical Denials Coding Review Specialist for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!

JOB SUMMARY AND QUALIFICATIONS

Seeking a Clinical Denials Coding Review Specialist, who is responsible for applying correct coding guidelines and payor requirements as it relates to researching, analyzing, and resolving outstanding clinical denials and insurance claims. This job requires regular outreach to payors and Practices. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you. We want you to apply today!

What you will do in this role:

• Triage incoming inventory, validating appeal criteria is met in compliance with departmental policies and procedures
• Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal as appropriate
• Compose technical denial arguments for reconsideration, including both written and telephonically
• Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
• Identify problem accounts/processes/trends and escalate as appropriate
• Utilize effective documentation standards that support a strong historical record of actions taken on the account
• Post denials, post or correct contractual adjustments, and post other non-cash related Explanation of Benefits (EOB) information
• Update patient accounts as appropriate
• Submit uncollectible claims for adjustment timely and correctly
• Resolve claims impacted by payor recoupments, refunds, and posting errors
• Assist team members with coding questions and provide resolution guidance
• Provide coding guidance and support to Practices
• Meet and maintain established departmental performance metrics for production and quality
• Maintain working knowledge of workflow, systems, and tools used in the department

What qualifications you will need:

• High school diploma or GED preferred
• Minimum two years related experience preferred, such as accounts receivable follow-up, insurance follow-up and appeals, insurance posting, professional medical/billing, medical payment posting, and/or cash application.
• Prior experience reading and interpreting Explanation of Benefits (EOB) required
• Coding certification through AHIMA or AAPC strongly preferred

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
“There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
If you find this opportunity compelling, we encourage you to apply for our Clinical Denials Coding Review Specialist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing apply today!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status

• Triage incoming inventory, validating appeal criteria is met in compliance with departmental policies and procedures
• Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal as appropriate
• Compose technical denial arguments for reconsideration, including both written and telephonically
• Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
• Identify problem accounts/processes/trends and escalate as appropriate
• Utilize effective documentation standards that support a strong historical record of actions taken on the account
• Post denials, post or correct contractual adjustments, and post other non-cash related Explanation of Benefits (EOB) information
• Update patient accounts as appropriate
• Submit uncollectible claims for adjustment timely and correctly
• Resolve claims impacted by payor recoupments, refunds, and posting errors
• Assist team members with coding questions and provide resolution guidance
• Provide coding guidance and support to Practices
• Meet and maintain established departmental performance metrics for production and quality
• Maintain working knowledge of workflow, systems, and tools used in the departmen