Manager Medical Insurance Appeals

About This Role

Manage all activities related to monitoring and appealing denials from Third Party Payers within HCA Healthcare's revenue cycle management, ensuring efficient and effective processes.

Responsibilities

• Manage daily activities and inventory related to SSC Appeals function
• Ensure 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

Requirements

• Bachelor’s Degree in Business or related field or equivalent work experience
• Minimum one to three years’ experience in related area
• Two years healthcare management experience or current participant in the Parallon Manager Trainee Program
• Experience with Insurance Follow up

Qualifications

• Bachelor’s Degree in Business or related field or equivalent work experience
• Minimum one to three years’ experience in related area, with two years being healthcare management experience or current participant in the Parallon Manager Trainee Program

Benefits