Parallon Job - 39445167 | CareerArc
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Company: Parallon
Location: Norcross, GA
Career Level: Mid-Senior Level
Industries: Healthcare, Pharmaceutical, Biotech

Description

Description

SHIFT: Work From Home
SCHEDULE: Full-time

Do you want to be a part of a family and not just another employee? Are you looking for a work environment where diversity and inclusion thrive? Submit your application today and find out what it truly means to be a part of a team. 

At HCA Healthcare, you have options. You can choose from a variety of benefits to create a customizable plan. You have the ability to enroll in several medical coverage plans including vision and dental. You can even select additional a la carte benefits to meet all your needs. Enroll in our Employee Stock Purchase Plan (ESPP), 401k, flex spending accounts for medical and childcare needs, and participate in our tuition reimbursement and student loan repayment programs.

HCA Healthcare is dedicated to the growth and development of our colleagues. We will provide you the tools and resources you need to succeed in our organization. We are currently looking for an ambitious Prebill Denials Nurse to help us reach our goals. Unlock your potential here!

As a Prebill Denials Nurse, you will review post discharge, prebill accounts that do not have an authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that require clinical expertise. Communicates with third party payors to resolve discrepancies prior to billing. Accurately and concisely documents all communications and action taken on the account in accordance with policies and procedures. Escalate medical review request and/or denial activities to management as needed.

What you will do in this role:

• Work post discharge, prebill accounts efficiently and effectively on a daily basis to resolve accounts with “no auth numbers, ALOS vs. authorized days or other discrepancies.

• Evaluates clinical documentation on multiple patient accounts and escalates issues through the established channels.

• Perform accurate and timely documentation of all review activities based on policy and procedure.

• Demonstrates a working knowledge of managed care agreements based on available resources which may include and not be limited to payer UM Manual, policy and procedure, facility contract information. Escalates variations timely.

• Work assigned accounts in eRequest to resolve outstanding issues.

• Report insurance denial trends identified during daily operational assignments.

• Contact facilities, physicians' offices and/or insurance companies to resolve denials/appeals if needed.

• Demonstrates knowledge of regulatory requirements, Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives.

• Assess CPT code(s) for outpatient accounts that require authorization when accounts have not been coded.

• Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous.

Qualifications

EDUCATION

Registered Nursing degree and current licensure

EXPERIENCE

Healthcare experience in an acute care hospital. Utilization Review, appeals, denials, managed care contracting, experienced preferred.

CERTIFICATE/LICENSE

RN with current state licensure.

Parallon is an industry leader in revenue cycle services. We partner with over 650 hospitals and 2,400 physician practices nation-wide. Our parent company, HCA Healthcare has been consistently named a World's Most Ethical Company by Ethisphere and is ranked in the Fortune 100.

We are a family 270,000 strong! Our Talent Acquisition team is reviewing applications immediately. Highly qualified candidates will be promptly contacted by our hiring managers for interviews. Submit your resume today to join our community of caring!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Notice

Our Company's recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.

For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.


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