HCA, Hospital Corporation of America Clinical Appeal Specialist LPN in Houston, Texas

  • Job Summary*– Handles appeals requiring clinical input or interpretation

Key Responsibilities

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

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

  • Identify problem accounts and escalates as appropriate

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

  • Work with guarantors to secure payment on account balances outstanding for clinical reasons

  • 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

  • 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

  • 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


  • Associate’s Degree preferred


  • At least one year case management experience required

Title: Clinical Appeal Specialist LPN

Location: Texas-Houston-Shared Services - Houston

Requisition ID: 08948-123824