Nurse Administrator Salary in Nashville, TN

Possess a thorough working knowledge of the revenue cycle management process. Responsible for the research and resolution of aging account receivables to that are either unpaid or incorrectly paid. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety.At The Little Clinic, we are on a mission to simplify healthcare in America. We take pride in knowing we are helping individuals live healthier lives right in our communities. If you have a passion for helping others, we want to hear from you! Our clinics are staffed by board-certified nurse practitioners or physician assistants, licensed practical nurses, and patient care technicians who all work as a team to supply high-quality, affordable healthcare found in convenient retail settings. The primary focus of our healthcare team is to promote health and wellness through diagnosis and treatment of illnesses, preventative medicine, and individualized patient education. Here, people matter. That's why we strive to supply the ingredients you need to create your own recipe for success at work and in life. We help feed your future by supplying the value and care you need to grow. So, whether you're looking for balanced, competitive benefits and rewards or ongoing opportunities for growth and development- we have you covered. We are always looking for extraordinary talent to join our growing team!Minimum Position Qualifications: High school diploma 1+ year of insurance follow-up including working knowledge of the appeals resolution process Strong written, and oral communication skills Analytical and problem solving capabilities with close attention to detail. Excellent organizational and follow-up skills Thorough working knowledge of revenue cycle management including medical terminology,ICD-9, ICD-10, CPT-4 coding, Medicare reimbursement guidelines, billing and collection practices Ability to read and interpret EOB's Highly self-motivated, with ability to work independently and meet deadlines Ability to remain flexible during times of change and adjusts promptly and effectively Must be able to learn, understand, and apply new technologies Analyze, audit and resolve claims outstanding, denied, or incorrectly paid Review and respond to payer correspondence. Submit appeals as needed for denied claims. Contact insurance companies and navigate payer websites in order to secure and expedite insurance payments. Resolves patient billing inquiries. Document in detail all actions taken in accounts receivable system. Meet productivity expectations as outlined by supervisor. Recognize, document and notify Team Lead of trends resulting in nonpayment or incorrectly paid claims. Answer and resolve inbound calls from insurance carriers. Participate in process improvement initiatives as needed. Keep current with Medicare and other third party administrators regulations and procedures. Manage any special projects requested by supervisor or team lead. Must be able to perform the essential functions of this position with or without reasonable accommodation.

Pulmonx is seeking an experienced Regional Business Director to join us and lead our high-performing Heartland Region sales team! This region consists of Indiana, Arkansas, Tennessee, Kentucky and West Virginia and to best support the business this individual should live in the Nashville, TN area.This position is responsible for delivering, in their respective region, on our sales and marketing objectives. They will manage the market development and sale of the Pulmonx product line by developing key customer relationships with interventional pulmonologists, pulmonologist, thoracic surgeons, general practitioners/Internal medicine and other key healthcare stakeholders throughout one's respective Area/Region. This includes hiring, directing and managing a direct sales force. This position will also be responsible for developing key customer relationships among physicians, nurses, and hospital administrators in the area.Responsibilities: Identify, hire, train, develop, direct, motivate and retain talented sales professionals and through and with them meet or exceed our specific sales and market objectives. Develop and maintain strong relationships with key thought leaders in the Region and utilize these relationships to expand sales of Pulmonx products, conduct professional education and provide input to new product development. Anticipate open territories and recruit appropriately so as to minimize open territory days. Execute against the monthly, quarterly and annual sales plan for Pulmonx products in the Region. Manage within the financial plan the annual headcount and expense budget necessary to exceed sales quota. Maintain average selling prices (ASP's) at the level of the sales plan. Oversee budget for domestic sales and support personnel. Plan and implement sales activities to meet sales goals set by senior management Responsible for regional field service and support activities. Responsible for an overall Region sales quota attainment based on performance of direct sales resources or headcount. Develop key relationships with key interventional pulmonologists, thoracic surgeons, general practitioners/internists, nurses, and hospital administrators. Train physicians on the proper use the Company's products and assisting them as appropriate during cases. Ensure Territory Managers and other Pulmonx field sales personnel are trained on the proper use of the Company's products and able to assist physicians as appropriate during commercial cases. Provide market intelligence feedback to marketing and senior management on things such as pricing, reimbursement, competitive strategies and tactics, demonstration techniques, customer training needs, etc. Support local meetings and conventions of key target societies or groups. Conduct routine 3-day field visits with Pulmonx Territory Managers and manage their performance with direct support and clear direction; field visit letters; motivational letters and sales rankings; contest participation; and regional team sales meetings.Requirements Bachelor of Arts/Science from an accredited university required 4+ years of documented management success in medical device sales. Direct experience in hiring, managing and developing high-performing field personnel. Experience developing and driving commercialization of new technology. Endoscopy and/or operating room experience and a demonstrated ability to work with interventionalist, clinicians and surgeons is required. Experience with the sales process for interventional pulmonology products is a plus. Excellent interpersonal and communication skills A passion for the customer, patient and product supported by strong relationships and closing skills Knowledge of target pulmonary intervention procedures and how to use professional education for training purposes. Strong work ethic, high energy/drive and personal integrity based on a strong value system. Mature, good business judgment skills, flexible, self-motivated, team oriented, charismatic, and strong leadership skills.Extensive travel required. Up to 70% travel.Compensation: Base + Variable compensation $265K at planPlease note that an application and resume must be completed and submitted for consideration for this opportunity.Pulmonx Corporation is an Equal Opportunity Employer and embraces diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any characteristic protected by applicable law.#LI-SH1PDN-9bd374b6-2750-4f07-a5dd-ef94797c0072

Cigna Medicare Part C Appeals Reviewer: Appeals Processing AnalystWe will depend on you to communicate some of our most critical information to the correct individuals regarding Medicare appeals and related issues, implications and decisions.The Case Management Analyst reports to the Supervisor/Manager of Appeals and will coordinate and perform all appeal related duties in a Medicare Advantage Plan. These appeals will include requests for decisions regarding denials of medical services as well as Part B drugs. The Case Management Analyst will be responsible for analyzing and responding appropriately to appeals from members, member representatives and providers regarding denials for services and denials of payment via oral and written communication; researching and applying pertinent Medicare and Medicaid regulations to determine the outcome of the appeal; provide oversight and assistance to Medical Management staff with resolution of appeal by interpreting Medicare and Medicaid regulations; reviewing documentation to ensure that all aspects of the appeal have been addressed properly and accurately; e) prepare case files for submission to Independent Review Entity, which also include writing required case summary on behalf of the plan to support appeal resolution.This position is full-time (40 hours/week) with the scheduled core business hours generally 7:00 am - 6:00 pm CST - Thursday through Sunday with occasional holiday coverage. The position requires 4 ten hour shifts per week. Job Requirements include, but not limited to: Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part CAbility to differentiate different types of requests Appeals, Grievances, coverage determination and Organization Determinations in order to ensure the correct processing of the appeal.Excellent prioritization and organizational skills; effectively manage competing priorities and multiple deadlines.Review, research and understand how request for plan services and claims submitted by consumers (members) and physicians/providers was processed and determine why it was deniedIdentify and obtain all additional information (relevant medical records, contract language and process/procedures) needed to make an appropriate determination of the appeal.Make an appropriate administrative determinations as to whether a claim should be approved or denied based on the available information and as well as research and provide a written detailed clinical summary for the Plan Medical Director. Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights are applicable and then if necessary, route to the proper area/department for their review and decision/responseComplete necessary documentation of final documentation of final determination of the appeals using the appropriate system applications, templates, communication process, etc.Communicate appeal information to members or providers with the required timeframes well as to all appropriate internal or external parties (regulatory agencies, plan administrators, etc.)Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendanceAdhere to department workflows, desktop procedures, and policies.Work with all matrix partners to ensure accurate and timely processing of Medicare Appeals.Read Medicare guidance documents report and summarize required changes to all levels department management and staff.Support the implementation of new process as needed.Based on case work and departmental reporting, ability to identify and report trends and/or areas of opportunities to department management and peers. .Understand and investigate billing issues, claims and other plan benefit information. .Assist with monitoring, inquiries, and audit activities as needed.Additional duties as assigned.QualificationsEducation: Licensed Practical Nurse (LPN) or Registered Nurse (RN)3-5 years' experience in Medicare Advantage Health Plans or related experience in a healthcare setting handling complex inquiries and requests for serviceWorking knowledge of Medicare Advantage, Original Medicare and or Medicaid appeal regulations. Understanding of Local Coverage Determinations, National Coverage Determinations, Medicare claim process and plan rules along with working with of ICD9, ICD10Superb written and oral communication skills with particular emphasis on verbally presenting case summary and decisions.Must have the ability to work objectively and provide fact based answers with clear and concise documentation.Proficient in Microsoft Office products (Access, Excel, Power Point, Word).Prioritizes workflow on a consistent basis, applies key HIPAA and CMS guidelines in daily workflow, and meets turnaround times for assigned cases.Ability to multi-task and meet multiple competing deadlines.Ability to work independently and under pressure.Attention to detail and critical thinking skills..Learning and Applying QuicklyA relentless and versatile learnerOpen to changeAnalyzes both successes and failures for clues to improvementExperiments and will try anything to find solutionsEnjoys the challenge of unfamiliar tasksQuickly grasps the essence and the underlying structure of anythingWritten CommunicationsIs able to write clearly and succinctly in a variety of communication settings and stylesCan get messages across that have the desired effectFunctional/Technical SkillsClinical and Non Clinical functional or technical proficiencyAppropriate judgment and decision making becauseKnowledge of applicable policy and business requirementsComputer skills and ability to work in various system applications.Detail oriented and Has the functional and technical knowledge and skills to do the job at a high level of accomplishmentTime ManagementSpends his/her time on what's importantQuickly zeros in on the critical few and puts the trivial many asideCan quickly sense what will help or hinder accomplishing a goalEliminates roadblocksUses his/her time effectively and efficientlyConcentrates his/her efforts on the more important prioritiesGets more done in less time than othersCan attend to a broader range of activitiesProblem SolvingUses rigorous logic and methods to solve difficult problems with effective solutionsProbes all fruitful sources for answersCan see hidden problemsLooks beyond the obvious and doesn't stop at the first answersIs excellent at honest analysisIf you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Cigna Medicare Part C Appeals Reviewer: Appeals Processing AnalystWe will depend on you to communicate some of our most critical information to the correct individuals regarding Medicare appeals and related issues, implications and decisions.The Appeals Processing Analyst reports to the Supervisor/Manager of Appeals and will coordinate and perform all appeal related duties in a Medicare Advantage Plan. These appeals will include requests for decisions regarding denials of medical services as well as Part B drugs. The Case Management Analyst will be responsible for analyzing and responding appropriately to appeals from members, member representatives and providers regarding denials for services and denials of payment via oral and written communication; researching and applying pertinent Medicare and Medicaid regulations to determine the outcome of the appeal; provide oversight and assistance to Medical Management staff with resolution of appeal by interpreting Medicare and Medicaid regulations; reviewing documentation to ensure that all aspects of the appeal have been addressed properly and accurately; e) prepare case files for submission to Independent Review Entity, which also include writing required case summary on behalf of the plan to support appeal resolution.This position is full-time (40 hours/week) with the scheduled core business hours generally 8:00 am - 5:00 pm CST - Monday through Friday with occasional weekend and holiday coverage. The position requires 5 eight hour shifts per week. Job Requirements include, but not limited to: Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part CAbility to differentiate different types of requests Appeals, Grievances, coverage determination and Organization Determinations in order to ensure the correct processing of the appeal.Excellent prioritization and organizational skills; effectively manage competing priorities and multiple deadlines.Review, research and understand how request for plan services and claims submitted by consumers (members) and physicians/providers was processed and determine why it was deniedIdentify and obtain all additional information (relevant medical records, contract language and process/procedures) needed to make an appropriate determination of the appeal.Make an appropriate administrative determinations as to whether a claim should be approved or denied based on the available information and as well as research and provide a written detailed clinical summary for the Plan Medical Director. Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights are applicable and then if necessary, route to the proper area/department for their review and decision/responseComplete necessary documentation of final documentation of final determination of the appeals using the appropriate system applications, templates, communication process, etc.Communicate appeal information to members or providers with the required timeframes well as to all appropriate internal or external parties (regulatory agencies, plan administrators, etc.)Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendanceAdhere to department workflows, desktop procedures, and policies.Work with all matrix partners to ensure accurate and timely processing of Medicare Appeals.Read Medicare guidance documents report and summarize required changes to all levels department management and staff.Support the implementation of new process as needed.Based on case work and departmental reporting, ability to identify and report trends and/or areas of opportunities to department management and peers. .Understand and investigate billing issues, claims and other plan benefit information. .Assist with monitoring, inquiries, and audit activities as needed.Additional duties as assigned.QualificationsEducation: Licensed Practical Nurse (LPN) or Registered Nurse (RN)3-5 years' experience in Medicare Advantage Health Plans or related experience in a healthcare setting handling complex inquiries and requests for serviceWorking knowledge of Medicare Advantage, Original Medicare and or Medicaid appeal regulations. Understanding of Local Coverage Determinations, National Coverage Determinations, Medicare claim process and plan rules along with working with of ICD9, ICD10Superb written and oral communication skills with particular emphasis on verbally presenting case summary and decisions.Must have the ability to work objectively and provide fact based answers with clear and concise documentation.Proficient in Microsoft Office products (Access, Excel, Power Point, Word).Prioritizes workflow on a consistent basis, applies key HIPAA and CMS guidelines in daily workflow, and meets turnaround times for assigned cases.Ability to multi-task and meet multiple competing deadlines.Ability to work independently and under pressure.Attention to detail and critical thinking skills..Learning and Applying QuicklyA relentless and versatile learnerOpen to changeAnalyzes both successes and failures for clues to improvementExperiments and will try anything to find solutionsEnjoys the challenge of unfamiliar tasksQuickly grasps the essence and the underlying structure of anythingWritten CommunicationsIs able to write clearly and succinctly in a variety of communication settings and stylesCan get messages across that have the desired effectFunctional/Technical SkillsClinical and Non Clinical functional or technical proficiencyAppropriate judgment and decision making becauseKnowledge of applicable policy and business requirementsComputer skills and ability to work in various system applications.Detail oriented and Has the functional and technical knowledge and skills to do the job at a high level of accomplishmentTime ManagementSpends his/her time on what's importantQuickly zeros in on the critical few and puts the trivial many asideCan quickly sense what will help or hinder accomplishing a goalEliminates roadblocksUses his/her time effectively and efficientlyConcentrates his/her efforts on the more important prioritiesGets more done in less time than othersCan attend to a broader range of activitiesProblem SolvingUses rigorous logic and methods to solve difficult problems with effective solutionsProbes all fruitful sources for answersCan see hidden problemsLooks beyond the obvious and doesn't stop at the first answersIs excellent at honest analysisIf you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Job Requirements include, but not limited to: Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part CAbility to differentiate different types of requests Appeals, Grievances, coverage determination and Organization Determinations in order to ensure the correct processing of the appeal.Excellent prioritization and organizational skills; effectively manage competing priorities and multiple deadlines.Review, research and understand how request for plan services and claims submitted by consumers (members) and physicians/providers was processed and determine why it was deniedIdentify and obtain all additional information (relevant medical records, contract language and process/procedures) needed to make an appropriate determination of the appeal.Make an appropriate administrative determinations as to whether a claim should be approved or denied based on the available information and as well as research and provide a written detailed clinical summary for the Plan Medical Director. Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights are applicable and then if necessary, route to the proper area/department for their review and decision/responseComplete necessary documentation of final documentation of final determination of the appeals using the appropriate system applications, templates, communication process, etc.Communicate appeal information to members or providers with the required timeframes well as to all appropriate internal or external parties (regulatory agencies, plan administrators, etc.)Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendanceAdhere to department workflows, desktop procedures, and policies.Work with all matrix partners to ensure accurate and timely processing of Medicare Appeals.Read Medicare guidance documents report and summarize required changes to all levels department management and staff.Support the implementation of new process as needed.Based on case work and departmental reporting, ability to identify and report trends and/or areas of opportunities to department management and peers. .Understand and investigate billing issues, claims and other plan benefit information. .Assist with monitoring, inquiries, and audit activities as needed.Additional duties as assigned.QualificationsEducation: Licensed Practical Nurse (LPN) or Registered Nurse (RN)3-5 years' experience in Medicare Advantage Health Plans or related experience in a healthcare setting handling complex inquiries and requests for serviceWorking knowledge of Medicare Advantage, Original Medicare and or Medicaid appeal regulations. Understanding of Local Coverage Determinations, National Coverage Determinations, Medicare claim process and plan rules along with working with of ICD9, ICD10Superb written and oral communication skills with particular emphasis on verbally presenting case summary and decisions.Must have the ability to work objectively and provide fact based answers with clear and concise documentation.Proficient in Microsoft Office products (Access, Excel, Power Point, Word).Prioritizes workflow on a consistent basis, applies key HIPAA and CMS guidelines in daily workflow, and meets turnaround times for assigned cases.Ability to multi-task and meet multiple competing deadlines.Ability to work independently and under pressure.Attention to detail and critical thinking skills..Learning and Applying QuicklyA relentless and versatile learnerOpen to changeAnalyzes both successes and failures for clues to improvementExperiments and will try anything to find solutionsEnjoys the challenge of unfamiliar tasksQuickly grasps the essence and the underlying structure of anythingWritten CommunicationsIs able to write clearly and succinctly in a variety of communication settings and stylesCan get messages across that have the desired effectFunctional/Technical SkillsClinical and Non Clinical functional or technical proficiencyAppropriate judgment and decision making becauseKnowledge of applicable policy and business requirementsComputer skills and ability to work in various system applications.Detail oriented and Has the functional and technical knowledge and skills to do the job at a high level of accomplishmentTime ManagementSpends his/her time on what's importantQuickly zeros in on the critical few and puts the trivial many asideCan quickly sense what will help or hinder accomplishing a goalEliminates roadblocksUses his/her time effectively and efficientlyConcentrates his/her efforts on the more important prioritiesGets more done in less time than othersCan attend to a broader range of activitiesProblem SolvingUses rigorous logic and methods to solve difficult problems with effective solutionsProbes all fruitful sources for answersCan see hidden problemsLooks beyond the obvious and doesn't stop at the first answersIs excellent at honest analysisIf you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.