Appeals Manager

  • HCA
  • Nashville, TN, USA
  • Feb 07, 2018

Job Description

Job Code: 08942-145071


No Weekends

The Appeals Manager is responsible for managing all activities related to monitoring and appealing denials received from Third Party Payers.

Duties (included but not limited to):
• Manage daily activities and inventory related to SSC Appeals function, ensuring processes are performed accurately, efficiently and effectively within all established operational and SOX guidelines
• Analyze trends in insurance denials and work with insurance companies to resolve underlying reasons for denials
• Manage recurring coding or clinical documentation issues and correct the underlying causes for errors
• Coordinate with all necessary departments related to contract issues
• Perform QA for all processes within Appeals
• Screen, interview, and hire new employees
• Arrange for training of new employees
• Review each staff member's productivity on a monthly basis and performing annual evaluations
• Counsel staff with disciplinary and productivity issues
• Work as a liaison between the Appeals staff and other SSC staff
• Resolve issues escalated by Appeals staff
• Conduct monthly staff meetings

  • Bachelor's Degree in Business or related field required. Equivalent work experience may substitute education requirements.

  • Minimum three years' experience in related area with two of these years being healthcare management experience OR completion of the Parallon Manager Trainee Program.

  • N/A

Last Edited: 02/05/2018