Clinical Appeals Nurse

Location
Nashville, Tennessee
Salary
Competitive Salary
Posted
Jan 24, 2018
Closes
Mar 26, 2018
Ref
08942-144479
Specialty
Med / Surg
Contract Type
Permanent
JOB TITLE: Clinical Appeals Specialist
GENERAL SUMMARY OF DUTIES - Handles appeals requiring clinical input or interpretation
SUPERVISOR - Logging Manager
SUPERVISES - N/A
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
 Monitor insurance denials by running appropriate reports and contacting insurance companies to
resolve claims denied for clinical reasons
 Identify coding or clinical documentation issues and work to correct the errors in a timely manner.
 Identify problem accounts and escalates as appropriate
 Update the patient account record to identify actions taken on the account.
 Work with guarantors to secure payment on account balances outstanding for clinical reasons
 Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
 Other duties as assigned

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