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RN or LVN Clinical Denials and Appeals Specialist, Patient Financial Services, Full time, Days

Company: PIH Health
Location: Whittier
Posted on: May 17, 2023

Job Description:

We're a nonprofit, regional healthcare network with two hospitals, numerous outpatient medical offices, a multi-specialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer and emergency services. Our leadership is dedicated to putting patients first-a cornerstone of our mission, vision and values-as we deliver top-quality healthcare. From our extensive facilities in Whittier, California and Downey, California, PIH Health serves more than two million residents in Los Angeles and Orange Counties and throughout the San Gabriel Valley. This position, reporting to the PFS Director, is responsible for the management of clinical denials at the Whittier, Downey and Good Samaritan campuses, including timely submission of appeals as required by payer and regulatory requirements, root cause identification, education and training of case managers and physicians on denial prevention techniques, and the implementation of denial prevention workflows and processes across the IDS. In addition, as the team lead this position is responsible for ensuring the following responsibilities are assigned appropriately amongst team members and are completed timely: writing clinical appeals, submitting retro denial reviews, Medi-Cal TARs, and 1-day stay reviews. Lead is also responsible for providing training to staff struggling to meet productivity standards, holding team accountable for completing daily assignments, and escalating issues to the PFS Director, as appropriate.
Required Skills

  • Excellent verbal, written, and organizational skills is required
  • Knowledge of medical terminology and current third party payor reimbursement methodologies
  • Ability to follow chain of command
  • Self-motivated, proactive, and results oriented
  • Must be able to demonstrate sound decision making and prioritization skills, utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant others when administering or explaining care.
    Required Experience
    • Must have and maintain an active California LVN/RN license.
    • Minimum two (2) years of acute hospital work experience preferred.
    • Managed care and case management experience is highly preferred.
    • Proficiency with main-frame and personal computers. Beyond the benefits that come with working for the area's leading community healthcare provider - one that also recognizes the need to ensure patient safety and comfort - you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V
      12401 Washington Blvd.
      FLSA Status
      Zip Code

Keywords: PIH Health, Whittier , RN or LVN Clinical Denials and Appeals Specialist, Patient Financial Services, Full time, Days, Accounting, Auditing , Whittier, California

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