Denials Nurse - Northridge, United States - REGAL MEDICAL GROUP, INC

REGAL MEDICAL GROUP, INC

Verified Company

Northridge, United States

6 days ago

Posted by:

Mark Lane

beBee recruiter

Description

Position Summary:

Essential Duties and Responsibilities include the following:

Understand all aspects of the functionality of Access Express with respect to prior authorization and the denials
Complete assigned tasks accurately and within specified time limits
Maintain smooth working relations with coworkers and supervisors, Be a "Team Player"
Anticipate future events, set realistic goals, timetables, coordinate activities to ensure smooth work flow and time management
Understand, promote and review with the principles of medical management to facilitate the right care at the right time in the right setting
Understand all Regal Medical Management policies and procedures
Communicate effectively and interact with the department managers, nurses, coordinators, regional medical directors and staff daily or as indicated regarding all denials processes
Maintain a working relationship with denials coordinators, the prior auth teams, pharmacy team, medical directors, and network management
When necessary, act as liaison between the prior auth coordinators, prior auth nurses, and medical directors
Maintain regulatory Turnaround Time Standards per regulatory guidelines
Document accurately and completely all necessary information in authorization notes
Communicating with the prior auth teams and medical directors for those denials needing clarification with an accurate summary of the case and recommendation
Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner
Identifies denials department needs and report to management for improvement opportunities
All other duties as directed by management

The pay range for this position at commencement of employment is expected to be between $ $50.00 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment.

Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees.

For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members.

As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

Employerpaid comprehensive medical, pharmacy, and dental for employees
Vision insurance
Zero copayments for employed physician office visits
Flexible Spending Account (FSA)
Employer-Paid Life Insurance
Employee Assistance Program (EAP)
Behavioral Health Services

Savings and Retirement:

401k Retirement Savings Plan
Income Protection Insurance

Other Benefits:

Vacation Time
Company celebrations
Employee Assistance Program
Employee Referral Bonus
Tuition Reimbursement
License Renewal CEU Cost Reimbursement Program
Businesscasual working environment
Sick days
Paid holidays
Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Requirements:

Education and/or Experience: