At Parallon, you will work as a Clinical Denials Coding Review Specialist supporting HCA Healthcare's revenue cycle operations.
This role focuses on reviewing clinical denials, applying correct coding guidelines and payer requirements, and researching, analyzing, and resolving outstanding insurance claims. The position includes regular outreach to payors and practices and is performed from home, with a requirement to live within 60 miles of an HCA facility in designated states.
Key responsibilities include:
- Triage incoming inventory and validate that appeal criteria are met in accordance with departmental policies and procedures
- Review Medicare Recovery Audit Contractor (RAC) recoupment requests and process or appeal them as appropriate
- Compose technical denial arguments for reconsideration, both in writing and by phone
- Overcome objections that prevent claim payment and work toward commitment for payment
- Identify problem accounts, process issues, and trends, then escalate when needed
- Maintain documentation standards that support a strong historical record of account activity
- Post denials, contractual adjustments, and other non-cash Explanation of Benefits (EOB) information
Requirements & Qualifications
Qualifications
- Minimum 2 years of related experience in one or more of the following: accounts receivable follow-up, insurance follow-up and appeals, insurance posting, professional medical billing, medical payment posting, and/or cash application
- Prior experience reading and interpreting Explanation of Benefits (EOB) required
- Coding certification through AHIMA or AAPC strongly preferred
- Must live within 60 miles of an HCA facility in ID, UT, NV, NH, TX, KS, MO, KY, TN, VA, GA, FL, SC, or NC
Benefits & Perks
Benefits and perks
- Medical, prescription drug, dental, vision, behavioral health, and telemedicine coverage
- Free counseling and referral services
- Paid time off, paid family leave, short-term disability, long-term disability, and leaves of absence
- 401(k) with 100% match on 3% to 9% of pay, based on years of service
- Employee Stock Purchase Plan
- Flexible spending accounts and banking partnerships
- Tuition assistance, student loan assistance, certification support, and dependent scholarships
- Fertility and family-building support, adoption assistance, life insurance, supplemental health protection, auto and home insurance, legal counseling, identity theft protection, and consumer discounts
Location
Tennessee, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago
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