HCA, Hospital Corporation of America Assistant Director Appeals of Clinical Appeals (Full Time) San Antonio Shared Services Center in San Antonio, Texas

Parallon pioneered the modern-day concept of healthcare shared services more than 12 years ago, perfecting revenue cycle management best practices and customizable technologies for the industry’s largest healthcare provider in 700 facilities and 1000 physician practices. Today, our team of more than 13,000 revenue cycle professionals applies unmatched expertise, scale and proven processes daily to improve financial performance and long-term sustainability at facilities nationwide.

JobSummary–TheAppeals Assistant Directorwillberesponsiblefordailyoperationsofallfunctionsandoversightofall activitiesrelatedtomonitoringandappealingdenialsreceivedfromThirdPartyPayers,includingGovernmentand ManagedCareappeals.TheAssistant Director willserveasakeyliaisonbetweentheSSCCFO,DivisionCFO’s,Case ManagementDirector’s,DenialsManagers,FacilityCFO’s,PAD’s,andotherteammemberswithintheorganization regardingdenialsandappeals.

Supervises–AppealsDepartmentStaff

Duties(includedbutnotlimitedto): · OverseetheactivitiesandmanagementrelatedtoGovernmentandManagedCareappeals/denials,ensuringprocessesareperformedefficientlyandeffectively.

· MandatoryrootcauseanalysisofdenialsandworkcollaborativelywithPrebillDenialsDirectortounderstand rootcauseandtrendstodecreasenewdenialsandfinalwriteoffdenialsbyidentifyingoperational opportunitiesthatwilldecreasedenialsoverall,suchascontractlanguage,patientaccessprocesschanges, casemanagementcollaboration,appealopportunities,etc.

· ProvidesupportandguidancerelatedtotheDenialsManagementActionTeams(DMAT)

· Monitoring,trendingandcommunicatingwithSSCLeadership,CaseManagementDirector’s,Denials Managers,andFacilityLeadershipregardingdenialtrends,newdenialsandfinalwriteoffdenialsidentifiedviaEDW,Vista,andotherdenialstoolsreports.

· Mustdemonstratestrongcommitmenttostakeholderrelationshipsbytakingownershipofissuesandfacilitatingeffectiveoutcomesinatimelymanner.

· Understandandcommunicatecontractspecificissuesrelatedtotheresolutionofdisputedpayments,discountandallowancecalculationsforavarietyofpayerssuchasMedicare,Medicaid,HMO’s,PPO’s,IPA’s,employers,etc.

· Overseemanagementof Denialspersonnel,providingrecommendationsforhiring,promotion,salary adjustmentandpersonnelactionwhereappropriate.

· EscalatewhenappropriatetotheCorporatePaymentComplianceAVP.

· EstablishcontrolsandreviewmechanismsforPASpoliciesandprocedures.

· MonitortrendsandcommunicatesignificantshiftsinmarketoroperatingconditionstoPASandfacility leadership. · Identifyandimplementprocessimprovementsimproveservicestofacilitycustomers.

· Practiceandadheretothe“CodeofConduct”philosophyand“MissionandValueStatement”

· Otherdutiesasassigned.

Knowledge,Skills&Abilities · Organization-proactivelyprioritizesneedsandeffectivelymanagesresources · Communication-communicatesclearlyandconcisely · Leadership-guidesindividualsandgroupstowarddesiredoutcomes,settinghighperformancestandardsanddeliveringleadingqualityservices · Customerorientation-establishesandmaintainslong-termcustomerrelationships,buildingtrustandrespect

· Tacticalexecution-overseesthedevelopment,deploymentanddirectionofcomplexprogramsandprocesses · Policies&Procedures-articulatesknowledgeandunderstandingoforganizationalpolicies,proceduresandsystems · PCskills-demonstratesproficiencyinMicrosoftOfficeapplicationsandothersasrequired · Financialmanagement-appliestoolsandprocessestosuccessfullymanagetobudget · ProjectManagement-assessesworkactivitiesandallocatesresourcesappropriately

EDUCATION

Bachelor’sDegreeinBusinessorrelatedfield

Equivalentworkexperiencemaysubstitutedegreerequirement

EXPERIENCE

Payeranalysisexperience

Minimum5year’smanagementexperience

CERTIFICATE/LICENSE

CPAhighlypreferred

Parallon is an Equal Opportunity Employer (EOE),**Minority/Female/Veteran/Disabled, offering a great work environment, challenging career opportunities, and competitive compensation.

Lack of information can delay the application process, and therefore applicants should be thorough in completing the online application.

Title: Assistant Director Appeals of Clinical Appeals (Full Time) San Antonio Shared Services Center

Location: Texas-San Antonio-Shared Services - San Antonio

Requisition ID: 08949-127280