Clinical Denials Coding Review Specialist

Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Clinical Denials Coding Review Specialist with Parallon you can be a part of an organization that is devoted to giving back!

This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).

Job Summary and Qualifications

As a work from home Clinical Denials Coding Review Specialist, you will be 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.

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

Requirements:

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

Benefits

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

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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.

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"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

Be a part of an organization that invests in you! We are reviewing applications for our Clinical Denials Coding Review Specialist opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!

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.