Clinical Appeals Manager
PAS - Dallas - Irving, Texas
Job Code: 08950-145357
Be part of a dynamic and cohesive leadership team, while making a difference in the lives of patients!
We serve and enable those who care for and improve human life in their communities.
As the Appeals Manager, you would be responsible for managing all activities related to monitoring and appealing denials received from Third Party Payers.
Duties include, but are not limited to:
- Manage daily activities and inventory related to SSC Appeals function, ensuring processes are performed accurately, efficiently and effectively within all established operational and SOX guidelines.
- Analyze trends in insurance denials and work with insurance companies to resolve underlying reasons for denials
- Manage recurring coding or clinical documentation issues and correct the underlying causes for errors.
- Coordinate with all necessary departments related to contract issues.
- Perform QA for all processes within Appeals
- Screen, interview, and hire new employees
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. The ability to communicate with staff, Parallon Management, Division and Group Executives
- 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 outcomes, setting high performance standards and delivering leading quality services
- Tactical execution - oversees the development, deployment and direction of complex programs and processes
- Project Management - assesses work activities and allocates resources appropriately
- 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 fast-paced 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.
- Bachelor’s Degree in Business or related field required. Equivalent work experience may substitute education requirements.
- Minimum three years’ experience in related area with two of these years being healthcare management experience OR completion of the Parallon Manager Trainee Program.
At Parallon, every employee is a valued member of our organization. You can expect to receive competitive salary, ongoing professional development, comprehensive benefits package, performance bonuses and more!
Check us out or follow us on LinkedIn at https://www.linkedin.com/company/parallon-business-solutions
Last Edited: 02/13/2018