Appeals Team Lead

HCA Nashville , TN 37201

Posted 2 weeks ago

Job Summary The Appeals Team Lead is responsible for performing daily appeals follow-up, monitoring denial trends/issues and assisting the Appeals Manager with training of the appeals department.

Supervisor Appeals Manager

Supervises N/A

Duties (included but not limited to):

  • Provides introductory and ongoing training and education to all Appeals staff to ensure that policies and procedures are followed

  • Meets with the Manager regularly to effectively communicate and resolve issues, set and prioritize goals and improve processes

  • Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards, including performing QA reviews for staff

  • Maintains established departmental policies and procedures, objectives, patient and customer service policies

  • Assists with payroll activities for team members (i.e. edit sheets)

  • Assists manager with development and implementation of project and department action plans

  • Monitors insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons

  • Identifies coding or clinical documentation issues and work to correct the errors in a timely manner

  • Identifies problem accounts and/or trended issues and escalates as appropriate

  • Updates the patient account record to identify actions taken on the account

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

  • Performs other duties as assigned

KNOWLEDGE, SKILLS & ABILITIES

  • Organization - proactively prioritizes needs and effectively manages resources

  • 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

  • Leadership - guides individuals and groups toward desired outcome by providing

training, advice and feedback to assist/support employees in achieving established

performance standards

  • Tactical execution - assist in monitoring operational processes and making

recommendations for changes/adjustments as needed during the implementation or

change to new products or processes

  • Policies & Procedures - demonstrates knowledge and understanding of organizational

policies, procedures and systems

  • Basic skills - demonstrates ability to organize, perform and track multiple tasks

accurately in short timeframes, have ability to work quickly and accurately in a fastpaced

environment while managing multiple demands, ability to work both

independently and collaboratively as a team player, adaptability, analytical and problem

solving ability and attention to detail and 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

EDUCATION

High School diploma or GED required.

EXPERIENCE

  • At least one year of related experience required.

#ParallonBCOM


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Appeals Team Lead

HCA