HCA, Hospital Corporation of America Appeals Specialist in Orange Park, Florida

Job Summary– The Appeals Specialist is responsible for performing end to end tasks for technical appeals.

Supervisor–Appeals Manager

Duties (included but not limited to):

  • Triage incoming inventory for the Appeals team, validating appeal criteria is met

  • Compose technical denial arguments for reconsideration, including both written and telephonically

  • Identify contract protection that can be leveraged to overturn denials.

  • Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument

  • Identify problem accounts/processes/trends and escalate as appropriate Utilize effective documentation standards that support a strong historical record of actions taken on the account. Ability to perform basic math to ensure accurate statement of accounts receivable

  • Meet the productivity and quality standards of the organization

  • Timely completion and comprehension of all educational requirements

  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”

  • Other duties as assigned

    KNOWLEDGE, SKILLS & ABILITIES

    Communication- communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately.

    Customer orientation- establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations

    Interpersonal skills- able to work effectively with other employees, patients and external parties

    PC skills- demonstrates proficiency in Microsoft Office applications and others as required

    Policies & Procedures- demonstrates knowledge and understanding of organizational policies, procedures and systems

    Technical skills- Professional presentation skills needed to represent facilities in legal issues.

    Basic skills- able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately

    Clinical skills –ability to read and interpret medical records a plus

    EDUCATION

    High school diploma or GED

    EXPERIENCE

    Minimum one year of experience in related area required

    #ParallonBCOM

Job: *Other

Title: Appeals Specialist

Location: Florida-Orange Park-Shared Services - Orange Park

Requisition ID: 08945-152931