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RN / Texas / Permanent / Clinical Appeals Nurse Job

Company: HCA.
Location: Houston
Posted on: February 16, 2020

Job Description:

Description SHIFT: Work From Home

SCHEDULE: Full-time

Do you want to be a part of afamily and not just another employee? Are you looking for a work environmentwhere diversity and inclusion thrive? Submit your application today and findout what it truly means to be a part of a team. At HCA Healthcare, you haveoptions. You can choose from a variety of benefits to create a customizableplan. You have the ability to enroll in several medical coverage plansincluding vision and dental. You can even select additional a la carte benefitsto meet all your needs. Enroll in our Employee Stock Purchase Plan (ESPP),401k, flex spending accounts for medical and childcare needs, and participatein our tuition reimbursement and student loan repayment programs. HCA Healthcare is dedicated tothe growth and development of our colleagues. We will provide you the tools andresources you need to succeed in our organization. We are currently looking foran ambitious Clinical Appeals Nurse to help us reach our goals. Unlock your potentialhere! As a Clinical Appeals Nurse, you will be responsible for handling appeals requiring clinicalinput or interpretation. What you will do in thisrole:

  • Compose clinical appealletters to send to payers for denial reconsiderations utilizing documentation,contract language, or voice recordings as applicable
  • Present a concise medical summary within each appeal based onsupport from the medical record
  • Demonstrate understanding of use of all Medical Necessitysoftware, including but not limited to InterQual
  • Demonstrate ability to interpret medical payer policy requirements
  • Strong ability to research evidence-based practices
  • Contact appropriate parties (internal and/or external) as neededfor additional information to properly formulate the clinical appeal.
  • Determine root cause of each denial and apply company-specificcoding for trending and analysis
  • Update the patient account record to identify actions taken on theaccount
  • Identify problem accounts/processes/trends and escalate asappropriate
    Qualifications

Keywords: HCA., Houston , RN / Texas / Permanent / Clinical Appeals Nurse Job, Healthcare , Houston, Texas

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