Compliance RN

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Introduction

Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our Compliance RN opening with Work from Home today and find out what it truly means to be a part of the HCA Healthcare team.

Benefits

Work from Home, 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.

We are seeking a(an) Compliance RN for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!

Job Summary and Qualifications

The Compliance Nurse 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 be critical in supporting 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 details is required.

What you will do in this role:

• 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, other relevant documents; recommend next steps for resolution.
• Demonstrate understanding of use of all Medical Necessity software, including but not limited to InterQual©.
• Demonstrate ability to interpret medical payer policy requirements.
• Strong ability to research evidence-based practices.
• Contact appropriate parties (internal and/or external) as needed for additional information to properly formulate and evaluate a clinical summary.
• Utilize computer programs and software to ensure assigned cases are tracked and monitored in an efficient and effective manner.
• Review and apply contract language as necessary to clinical summaries.
• Utilize payer administrative manuals to dispute denied claims.
• Maintain and apply understanding of federal, state and local rules and regulations impacting denials.
• Maintain and apply understanding of HCA / Parallon policies and procedures and work protocols impacting denials.

What qualifications you will need:

• Licensed Practical / Vocational Nurse (LPN / LVN)
• Registered Nurse (RN)
• Associate Degree
• No Travel Required
• 1 years experience Required Years of Experience

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.

"Across HCA Healthcare's more than 2,000 sites of care, our nurses and colleagues have a positive impact on patients, communities and healthcare. Together, we uplift and elevate our purpose to give people a healthier tomorrow."- Jane Englebright, PhD, RN CENP, FAAN Senior Vice President and Chief Nursing Executive

If you find this opportunity compelling, we encourage you to apply for our Compliance RN opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing 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.