HCA, Hospital Corporation of America Appeals Team Lead in Largo, Florida
DUTIES INCLUDE BUT ARE NOT LIMITED TO: • Coordinate payor package spreadsheets submitted by the Appeals Department for all the various Managed Care payers using payer specific spreadsheet formats. • Participates in monthly payer calls and JOC meetings. Is prepared to discuss trended issues to include individual claims for bringing to resolution. • Demonstrates familiarity with key requirements within payer contracts to include but not be limited to: authorizations, notices of admission, timely filing, concurrent denials, peer to peer reviews, and pre-payment audits that can be referenced as needed in payer calls and JOC meetings. • Demonstrates familiarity with payer contract modeling and works closely with the modeling team as required. • Provides trended data to the management team for escalation to Senior Leadership, Strategic Pricing & Analytics, Legal Counsel and the Corporate Payment Compliance Team. • Maintains appropriate follow-up accordingly to corporate policy guidelines with payers on payer package responses. Ensures claims are documented and statused. • Provides new hire training and mentoring to include performing QA reviews. • Demonstrates knowledge of Business Objects and ability to generate adhoc reporting. • Participates in process improvement activities to include writing policy and procedures. • Participates in monthly facility meetings for reviewing denial root cause issues. Is prepared to provide trended data by facility. • Serve as the Appeals contact for the United Dedicated Unit.
KNOWLEDGE, SKILLS & ABILITIES: • Must have strong Excel skills, demonstrating intermediate or higher level of expertise. • Must have strong analytical skills. • Must be a self-starter and able to work independently.
EXPERIENCE: • Minimum of 2 years of Managed Care experience.
Title: Appeals Team Lead
Location: Florida-Largo-PAS Tampa
Requisition ID: 08947-124425