- Include the following. Others may be assigned.
- Validate denial reasons and ensures coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary,
- Participate in payor JOC
- Ability to trend issues and provide recommendations for resolution.
- Interprets insurance program procedures and provisions to resolve routine insurance billing inquires and problems.
- Documents clearly and concise account notes on all action taken on accounts
- Work with various department in order to resolve issues and able to provide timely feedback
- Must be able to pay attention to detail and have high quality of work.
- Able to maintain daily workload by meeting the standard productivity
- Understand DOFR
- Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations.
- Follow specific payer guidelines for appeals submission
- Escalate exhausted appeal efforts for resolution
- Work payer projects as directed
- Research contract terms/interpretation and compile necessary supporting documentation for appeals, Terms & Conditions for FINThrive adjudication issues, and referral to refund unit on overpayments.
- Perform research, makes determination of corrective actions, and takes appropriate steps to code the Denials Management System and route account appropriately.
- Escalate denial or payment variance trends to leadership team for payor escalation.
- Attends meetings as required
- Other duties as assigned
- Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements
- Intermediate knowledge of hospital billing form requirements (UB-04)
- Intermediate understanding of ICD-9, HCPCS/CPT coding and medical terminology
- Intermediate Microsoft Office (Word, Excel) skills
- Advanced business letter writing skills to include correct use of grammar and punctuation.
- High School Diploma or equivalent, some college coursework preferred
- 3 - 5 year experience in a hospital business environment performing billing and/or collections
-
KPC Global MSO Corona, United StatesRESPONSIBILITIES AND DUTIES: · • Ensure timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned. · • Contacts insurance companies via phone or website to secure authorization. · • Responsible to review ...
-
Authorization Specialist Hybrid $2,000 Sign on
2 weeks ago
KPC Global MSO Corona, United StatesJob Description · Job DescriptionRESPONSIBILITIES AND DUTIES: · Ensure timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned. · Contacts insurance companies via phone or website to secure authorization. ...
-
Patient Account Specialist I
3 weeks ago
KPC GLOBAL MEDICAL CENTERS INC. Santa Ana, United States**Hybrid $3,000 Sign-on Bonus** · Patient Account Specialist I (Hospital or Healthcare Exp Req) · Performs account follow up from third-party payers including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) ...
-
Psychiatric Nurse Practitioner
2 weeks ago
LifeStance Health Anaheim, United StatesAt LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives by improving access to trusted, affordable, and personalized mental healthcare. E ...
-
Patient Account Specialist I
2 weeks ago
KPC GLOBAL MEDICAL CENTERS INC. Anaheim, United StatesJob Description · Job DescriptionHybrid $2,000 Sign-on Bonus · Patient Account Specialist I (Hospital or Healthcare Exp Req) · Performs account follow up from third-party payers including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred ...
-
Development Manager
2 weeks ago
CAIR LA Anaheim, United StatesJob Description · Job DescriptionDevelopment Manager · Work Location: Anaheim, CA · Term: Regular, Full-time · Position Status: Exempt · Reports to: Executive Director · Salary: $70,000-$90,000 commensurate with skills and experience · Generous Benefits: 100% employer paid medica ...
-
Process Improvement Manager
1 week ago
Elevance Health Cerritos, United StatesJob Family: BSP > Process Improvement · Type: Full time · Date Posted: May 22, 2024 · Anticipated End Date: Jun 24, 2024 · Reference: JR118175 · Description · **JR118175 Process Improvement Manager** · This exciting role reports to the national director of clinical standardizatio ...
-
Titanium Healthcare Fountain Valley, United States**Job Summary**: The Community Support Outreach Specialist is responsible for customer services tasks that ensure current and prospective members that have the information and assistance they need for the Community Support Program. · **Position Responsibilities**: · - Follows est ...
-
Azure Manager
1 week ago
Easterseals Southern California Irvine, United StatesOverview: · Oversees and manages the enterprise-wide integration of Azure cloud services with on-premise VMware infrastructure. Supports and collaborates with the Microsoft Service Fabric and EDW teams to enhance infrastructure reliability and data accessibility. Designs and impl ...
-
Production Planner
1 week ago
Vista Outdoor Irvine, United StatesJob Description · Position Summary: · The production planner's role is to issue, maintain, and monitor purchase orders for assigned vendors to ensure on-time delivery. Maintaining an accurate order book is key to the success of this role. Planner will communicate buy plans and co ...
-
Pacific Mind Health Irvine, United States**Pacific Mind Spa** is a mental health wellness practice with a mission to build a world where everyone has access to exceptional mental healthcare. With several locations across the state, we strive to make quality care affordable while providing a nurturing environment for cli ...
-
Sales Representative
2 weeks ago
DC INTERNATIONAL LOGISTICS CO., LTD Diamond Bar, United States**company Description**: · We are a leading International Freight Forwarding company based in Los Angeles, committed to providing top-notch logistics solutions to our clients worldwide. With years of experience in the industry, we specialize in air, ocean, and ground freight serv ...
-
Intake Coordinator
1 week ago
Larry H. Parker Long Beach, United States**Description** · At Larry H. Parker, every single employee gets to make an impact. Our values guide the way we work with each other. It's a culture where you have the freedom to experiment and push your talents as far as they can go. · **Job Title**: Intake Coordinator · **Pay** ...
-
Bcba Clinical Supervisor
2 weeks ago
Coyne & Associates Education Corp Downey, United States_Are you ready to join an award-winning culture and help kids succeed in the process? Join us at Coyne...._ · - Check us out _Coyne is one of the highest-rated ABA Agencies on Glassdoor and is a local Top Workplace (awarded in 2017, 2018, 2019, 2021, & 2022) and was recently awar ...
-
Training Coordinator
3 weeks ago
Star View Community Services: Star School Solutions Long Beach, United States**Partner with us in making a positive change** · Join a community that's changing mental healthcare for the better. We have been certified as a Great Place to Work by our own employees for over 5 years running. Looking forward to your partnership in making a difference with us · ...
-
Training Coordinator
3 weeks ago
Star View Behavioral Health, Inc. Long Beach, United States**Partner with us in making a positive change**: · Join a community that's changing mental healthcare for the better. We have been certified as a Great Place to Work by our own employees for over 5 years running. Looking forward to your partnership in making a difference with us ...
-
Training Coordinator
3 weeks ago
Star View Behavioral Health, Inc. Long Beach, United States**Partner with us in making a positive change**: · Join a community that's changing mental healthcare for the better. We have been certified as a Great Place to Work by our own employees for over 5 years running. Looking forward to your partnership in making a difference with us ...
-
Bcba Clinical Supervisor
2 weeks ago
Coyne & Associates Education Corp Long Beach, United States_Are you ready to join an award-winning culture and help kids succeed in the process? Join us at Coyne...._ · - Check us out _Coyne is one of the highest-rated ABA Agencies on Glassdoor and is a local Top Workplace (awarded in 2017, 2018, 2019, 2021, & 2022) and was recently awar ...
-
Clinical Research Data Specialist Ii
3 weeks ago
Springer Nature Los Angeles, United States**Clinical Research Data Specialist II - Center for Translational Geroscience (Hybrid)**: · - Employer- Cedars-Sinai- Location- Los Angeles, California- Salary- Competitive- Closing date- 13 Jun 2024- Discipline · Health Science · Job Type · Researcher · Employment - Hours · Full ...
-
Degree Auditor/academic Counselor
3 weeks ago
UCLA Los Angeles, United StatesWe are a team of 18 staff members and 7 student employees headed by Associate Dean Wesel. We foster a team environment while also collaborating with campus partners. Currently, we have a hybrid work model and we are located in one suite.**Salary & Compensation** · - UCLA provides ...
Denials Management Specialist Hybrid $2,000 Sign on - Anaheim, United States - KPC GLOBAL MEDICAL CENTERS INC.
Description
Job Description
Job DescriptionThe Denials Management Specialist is responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to management, and generating appeals for denied or underpaid claims.DUTIES AND RESPONSIBILITIES
SKILLS & ABILITIES REQUIREMENTS:
REQUIREMENTS
EDUCATION / EXPERIENCE