Clinical Appeals Specialist Medicare RN or LPN

TriStar Health is the region's largest, most comprehensive healthcare provider with locations in Tennessee and Southern Kentucky. As a family of hospitals all with the same mission, vision and values, we pride ourselves on delivering patient-focused care in the communities where you live and work. We lead the industry in developing and implementing patient safety initiatives to deliver the highest quality care.

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 (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA). Do you want to join an organization that invests in you as a Clinical Appeals Specialist Medicare RN or LPN? 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. 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 Clinical Appeals Specialist Medicare RN or LPN like you to be a part of our team. Job Summary and Qualifications: Seeking a Clinical Appeals Specialist Medicare RN or LPN , who is responsible for handling appeals requiring clinical input or interpretation. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you. We want you to apply today!

Review medical records and other documentation to compose RAC appeal letter with concise medical summary based on support from the medical record and prepare RAC appeal package accordingly. Demonstrate ability to interpret CMS policy requirements. Strong ability to research evidence-based practices. Identify problem claims and appeals and escalate as appropriate. Update the RRT and any other systems (Artiva, SSD Web Tools) to identify actions taken on the account.