-
Appeals Specialist
1 week ago
Parallon Franklin, United StatesDescription · Introduction · Do you want to join an organization that invests in you as an Appeals Specialist? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. · Bene ...
-
Appeals Specialist
2 weeks ago
Parallon Brentwood, United StatesDescription · Introduction · Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our Appeals Specialist opening with Parallon today and find out what it truly means to be a part of the HCA Healthcare team. · Benefits · Para ...
-
Appeals Specialist
1 week ago
Blue Cross Blue Shield of South Carolina Nashville, United StatesJoin our appeals team to performs non-medical reviews and processes redetermination letters. Description CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, h Appeals Specialist, Appeals, ...
-
Appeals Specialist
2 weeks ago
BlueCross BlueShield of South Carolina Nashville, United StatesWhy should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades weve been part of the national landscape, with our roots firmly embedded in the South Carolina community Appeals Specialist, Appeals, S ...
-
Appeals Specialist
2 weeks ago
Blue Cross and Blue Shield Association Nashville, United StatesSummary · Join our appeals team to performs non-medical reviews and processes redetermination letters. · Description · CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, health care provi ...
-
Appeals Specialist
3 days ago
BlueCross BlueShield of South Carolina Nashville, United StatesSummary · Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the larges ...
-
Clinical Appeals Specialist II
1 day ago
Community Health System Antioch, United StatesJob Description · Essential Duties and Responsibilities: include the following. Other duties may be assigned. · * File medical necessity and level of care appeals using InterQual and CMS guidelines as needed. · * Monitor clinical appeal processes for issues and trends and provide ...
-
Accts Receivable Spclst
6 days ago
IASIS Healthcare Franklin, United StatesAccts Receivable SpclstClick Here to Apply OnlineJob DescriptionLocation: Stewardship Health IncPosted Date: 4/16/2024Job Type: Full TimeDepartment: TexasLouisiana Accounts Receivable MCSETPosition Summary:Under the direction of the Manager and Supervisor of Accounts Receivable D ...
-
Seasonal Sales Associate
2 weeks ago
Lego Services LLC Franklin, United StatesJob Description · Seasonal Sales Associate (Brick Specialist) - Franklin, Tennessee · Are you excited to deliver inspirational retail experiences to · LEGO · fans of all ages? · Join the LEGO Brand Retail team as a Seasonal "Brick Specialist" and provide inspirational guest ...
-
Client Services Specialist
1 week ago
Veterans Sourcing Group Franklin, United StatesJob Title: Client Services Specialist · Pay Rate: $16.80/hr on W2 · Duration: 7 months · TN - REMOTE · Position Summary · ******** MANAGER WOULD LIKE CANDIDATES TO RESIDE IN THE CST OR EST TIME · ZONES ********* · ************ IF SELECTED CANDIDATE PERFORMS WELL, AND HAS EXCEPT ...
-
Revenue Specialist, VA
1 week ago
EnableComp Franklin, United StatesRecognized as a 2023 Top Workplace by the Tennessean, EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims. · O ...
-
Denial Management Specialist
4 weeks ago
SSC - Nashville Franklin, United StatesESSENTIAL DUTIES AND RESPONSIBILITIESThe Specialist will monitor assigned pools and duties in Artiva, HMS, Hyland, BARRT and other host systems and applications with currency to follow up dates. · File appeals as needed to resolve payer denials and work with payers and monitor a ...
-
Revenue cycle specialist
4 weeks ago
Randstad Franklin, United States TEMPORARY, Full time*This positon is 100% in office* We are seeking a Temporary Revenue Cycle Specialist to join our team in Franklin, TN. This position plays a critical role in ensuring the financial health of our organization by managing various aspects of the revenue cycle process. The ideal cand ...
-
Revenue Cycle Specialist
3 weeks ago
Acadia Healthcare Franklin, United StatesOverview: · Now Hiring : Revenue Cycle Specialist · Franklin, TN · Our Team: · We are improving the lives we touch. We need passionate, talented people working together who share our desire to create a world-class organization that sets the standard of excellence in the treat ...
-
housing specialist
3 weeks ago
SCO Family of Services Brentwood, United States Full timeJob Details · Description · Housing Specialist · Education and Parent Support Services · LOCATION: Brooklyn/Queens/Brentwood · PURPOSE OF THE POSITION : As part of SCO's Forward Journey Initiative, the Housing Specialist will work with youth as they prepare to transition to ...
-
Accounts Receivable Insurance Specialist
5 days ago
Vaco Brentwood, United StatesOur client in Brentwood, TN is seeking an Accounts Receivable Insurance Specialist to join their team. · This is a contract-to-hire position with a hybrid schedule. · Responsibilities: · Maintain aged insurance accounts receivable (AR) queues to ensure they remain current as p ...
-
Remote Analyst
2 weeks ago
Ovation Healthcare Brentwood, United StatesWelcome to Ovation Healthcare · At Ovation Healthcare, we've been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled ...
-
Revenue Cycle Specialist
2 weeks ago
Endodontic Practice Partners Brentwood, United StatesAre you the one? Come join our team and succeed with us · About us · Endodontic Practice Partners (EPP) is a nationwide partnership of private endodontic practices focused on patient care, clinical quality, and nationwide growth. We empower our practices to keep their individua ...
-
Banking Center Manager II
2 weeks ago
First Horizon Bank Nashville, United States Full timeLocation: Onsite in Nashville, TN · Summary · The Banking Center Manager manages all banking center employees and supervises day-to-day operations of the banking center while ensuring safety, operational soundness and excellent service levels. This position is also responsible fo ...
-
Denial Coding Review Specialist
1 day ago
HCA Nashville, United StatesIntroduction · Do you want to join an organization that invests in you as a Denial Coding Review Specialist? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. · Benefits ...
Clinical Appeals Specialist II - Franklin, United States - SSC - Nashville
Description
Essential Duties and Responsibilities:
include the following.
Other duties may be assigned. File medical necessity and level of care appeals using InterQual and CMS guidelines as needed.
Monitor clinical appeal processes for issues and trends and provide guidance and feedback to related departments as needed.
Track and manage clinical denials using current tools (manuals, training programs).Identify patterns and trends in denials; communicate to appropriate persons.
Maintain documentation regarding all payor resources regarding denials and appeals processes.Understand and apply CHS 10-Step Appeal Process for denied claims.
Know medical necessity criteria for outpatient testing and procedures.
Follow and enforce accepted safety practices for patients and the hospital. Report safety hazards and initiate appropriate action.
Participate in safety instructional programs.
Observe excellent customer service skills when dealing with patients, families and/or significant others, outside vendors, coworkers, and physicians.
Provide education to staff as appropriate.
Document all actions accordingly by documentation standards within Artiva, HMS and other business office systems as required.
Be familiar with policy and procedure manuals and other reference materials.
Ensure confidentiality of all patient accounts by following HIPAA guidelinesPerform additional duties as assigned or requested.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Knowledge/Abilities:
RequiredUnderstanding and utilization of medical necessity criteria for inpatient and outpatient services and procedures.
Understanding of the revenue cycle and the responsibility and goals of each areaMust be able to interact with all levels of hospital administration, physicians and other healthcare team members they impact the revenue cycleMust be able to follow directions and perform work according to departmental standards and must be able to function effectively under stressful conditions.
Excellent writing and communications skills as well as effective organizational skills a must./Reasoning Ability:
Ability to define problems, collect data, validate data, establish facts, and draw valid conclusions
Computer Skills:
RequiredMicrosoft officeEducation/Experience:RequiredMust have diploma/degree from an accredited school of nursing5 years of clinical nursing experience
Certificates and Licenses:
Current RN license to practice in statePreferredUtilization review and/or case management experience
