Medicaid Clinical Reviewer LPN LVN

Job Summary and Qualifications

The Medicaid Clinical Reviewer LPN/LVN is responsible for performing retrospective medical reviews based on patient eligibility and contract requirements.

• Perform a retrospective review of medical records using clinical expertise and Medicaid guidelines to determine medical necessity for emergent inpatient admissions and outpatient services.
• Perform clinical reviews and maintain clinical documentation in accordance with HCA policy, procedures, and job aids.
• Submit authorization request based on state deadlines using various State portals.
• Review deferred accounts and update according to payer request.
• Review denied accounts to determine justification for appeal requests.
• Maintain clinical documentation according to HCA’s documentation policy.
• Perform TAR reviews and completion of TAR requests according to Medi Cal format and deadlines.
• Knowledge of care management plans and services in order to implement that knowledge in a clinical setting.
• Maintain productivity requirement as established by leadership.
• Absorb and assist in the orientation and training of new clinical staff.
• Demonstrate proficiency in Microsoft Office applications and others as required.

Experience

• A minimum of one-year Revenue Cycle experience with denials, appeals, managed care, verifications, and precertification preferred.
• 1-2 years experience in acute care environment.
• 3 years experience with utilization management in managed care and/or hospital setting preferred.
• Experience working in a remote setting.

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 benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services.
• Wellbeing support, including free counseling and referral services.
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence.
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling.
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing.

Note

Eligibility for benefits may vary by location. 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.