Senior Medical Insurance Appeals Specialist

Senior Appeals Analyst

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. Do you want to join an organization that invests in you as a Senior Appeals Analyst? 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.

Parallon offers a total rewards package that supports the health, life, career, and retirement of our colleagues. The available plans and programs include comprehensive medical coverage, additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans, auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance, and more. Free counseling services and resources for emotional, physical, and financial wellbeing are also available. There is a 401(k) plan with a 100% match on 3% to 9% of pay (based on years of service), an employee stock purchase plan with 10% off HCA Healthcare stock, family support through fertility and family building benefits, referral services for child, elder, and pet care, consumer discounts, retirement readiness, education assistance, and time away from work program.

Note : Eligibility for benefits may vary by location. You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Senior Appeals Analyst like you to be a part of our team.

Job Summary and Qualifications

The Senior Appeals Analyst researches and resolves high dollar technical and top dollar clinical appeals through a concise understanding of payer contract language and clinical or technical justification. The position requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case, confidence, and strong persuasion skill set. Results oriented individual will be required to work through various options available to liquidate the most difficult top dollar appeals. Candidate will demonstrate ability to grow strategic payer relationships and obtain understanding of payer system to navigate through the appeals process. Critical thinking skills are necessary, as well as the ability to see trends that require escalation to the Payment Compliance Director. Responsible for bundling similar cases not resolved through the standard Payment Compliance process and escalate to Dispute Resolution Team for legal action.

What You Will Do In This Role

• Review technical and clinical denial arguments for reconsideration on top dollar accounts, including both written and telephonically through resolution process.
• Identify coding or clinical documentation issues and work to correct the errors in a timely manner.
• Identify contract protection that can be leveraged to overturn denials.
• 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 accounts.
• Identify and communicate contract interpretation issues and language discrepancies to leadership as appropriate.
• Identify Payer company trends and communicate trends to supervisor for further action / escalation.
• Serves as a subject matter expert in payer appeals resolution process.

Qualifications That You Will Need

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.

We are a family of 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Senior Appeals Analyst opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!

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.