Compliance Nurse Manager

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Introduction

Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Compliance Nurse Manager today with Parallon.

Benefits

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Come join our team as a Compliance Nurse Manager. We care for our community! Just last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations. Apply Today!

Job Summary and Qualifications

The Compliance Nurse Manager is responsible for providing clinical input or interpretation for denials that have remained unresolved or have been escalated under the Shared Service Center (SSC) operations pre-established protocols. This position will manage the clinical team and assist the Dispute Resolution Team prepare materials for HCA legal and external legal counsel to support the various clinically outstanding trended disputes, denial escalations, and No Surprises Act disputes. This position requires a highly skilled and trained individual. This position is critical in helping the dispute resolution strategy focused on denial cash conversion. Tracking large case volumes efficiently and effectively with technology while providing the highest levels of customer service and attention to detail is required.

What you will do in this role:

• Provide information supporting the legal efforts to pursue reimbursement for inappropriately denied claims, including interactions with internal and external counsel, retained clinical experts, and testimony during legal hearings as needed.
• Work directly with the Dispute Resolution Operations Team to ensure clinical reviews are completed promptly.
• Work closely with the Dispute Resolution Team management/leadership to evaluate clinical review processes, productivity measurements, and department goals.
• Ensure clinical reviews are completed to the standards set forth by the Dispute Resolution Team, HCA legal department, and external legal counsel.
• Monitor clinical denial trends and provide reports and summaries regarding clinical denials as needed.
• Provide Parallon Corporate and SSC team's feedback regarding opportunities to improve clinical review and appeals processes.
• Contact appropriate parties (internal and external) as needed for additional information to formulate and evaluate clinical summaries properly.
• Work with Clinical Team Lead to train new team members and perform QA on existing team members.
• Responsible for building, supporting implementation, and maintaining high-quality processes to maximize recoveries.
• Build a strong understanding of Parallon revenue cycle operations, including business processes, tools, and technologies.
• Compose, edit, review, or otherwise support concise clinical evaluations for disputed claims through review and assessment of denial reconsideration documentation, payer denial documentation, medical records, and other relevant documents.
• Demonstrate understanding of using all Medical Necessity software, including but not limited to InterQual© and Milliman.
• Demonstrate ability to interpret medical payer policy requirements.
• Demonstrate ability to work independently.
• Strong ability to research evidence-based practices.
• Utilize computer programs and software to track and monitor assigned cases efficiently and effectively.
• Review and apply contract language as necessary to clinical summaries.
• Maintain and apply understanding of federal, state, and local rules and regulations impacting denials and appeals.
• Maintain and apply understanding of HCA / Parallon policies and procedures and work protocols impacting denials and appeals.
• Meet all performance standards and goals set by management.

What qualifications you will need:

• Bachelor's Degree required.
• At least three years of case management or similar appeal experience required
• At least one year of prior supervisory experience
• State RN License required (Active)

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Compliance Nurse Manager opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.