Clinical Denials Management Program Coordinator RN
Not Disclosed•Full-TimeOn-site
location_on1536, East 77th Street, Florence-Firestone, Firestone Park, Los Angeles County, California, 90001, United States
About Cedars-Sinai
Align yourself with an organization that has a reputation for excellence. Cedars-Sinai has been awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also named the Advisory Board Company's Workplace of the Year, an annual award recognizing hospitals and health systems nationwide that demonstrate outstanding levels of employee engagement. U.S. News & World Report has named us one of America's Best Hospitals.
Our accomplished and compassionate staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation. We provide an outstanding benefit package that includes health care, paid time off, and a 403(B).
About the Role
Under the direction of Patient Financial Services, Compliance, and Revenue Integrity, the Clinical Denials Management Program Coordinator RN serves as the central point of contact for clinically based appeals between Cedars-Sinai Medical Center and outside payers. This role acts as a vital liaison between Patient Financial Services, Case Management, and other internal representatives to manage denial and appeal inquiries.
In this position, you will actively manage, maintain, and communicate denial and appeal activities, trends, and recommended corrective action plans to appropriate partners. You will identify and facilitate educational opportunities with case management departments, providers, and payers to decrease denials and improve the quality of service to patients. Additionally, you will provide periodic educational sessions regarding denial trends, changes in reimbursement mechanisms, and updates in contractual agreements that may affect case management processes.
Equal Opportunity
We take pride in hiring the best employees and are committed to a dynamic, inclusive environment. Our team reflects the diverse community we serve, and we welcome applicants from all backgrounds.
Work location
Work model: On-site
1536, East 77th Street, Florence-Firestone, Firestone Park, Los Angeles County, California, 90001, United States
Firestone Park, California
Key Responsibilities
- check_circleManage and communicate clinically based appeals between the hospital and outside payers
- check_circleAct as liaison for denial and appeal inquiries between departments and representatives
- check_circleMonitor and report on revenue recovery resulting from appeal efforts
- check_circleMaintain strict adherence to appeal submission timelines to avoid loss of appeal rights
- check_circleCommunicate utilization review information to payers to avoid denials for lack of clinical data
- check_circleReview all denials and determine appropriateness based on InterQual guidelines and professional judgment
- check_circleCollaborate with departments to develop corrective action plans addressing denial trends
- check_circleConstruct clinically-oriented appeal letters documenting rebuttals to denied days or services
- check_circleCoordinate communication for second-level appeals and recommend advancement to legal level
Requirements
- verifiedAssociate's degree or college diploma required
- verifiedBachelor's degree in healthcare, management, business administration or a related major preferred
- verifiedMinimum of 4 years of case management experience in an acute care setting required
- verifiedMinimum of 4 years of commercial/government denials and appeals experience preferred
- verifiedCurrent California RN license required
- verifiedCertified Case Management RN preferred
Nice to Have
Bachelor's degree in healthcare, management, business administration or a related major. Minimum of 4 years of commercial/government denials and appeals experience. Certified Case Management RN.
Benefits & Perks
check_circleHealth care coveragecheck_circlePaid time offcheck_circle403(B) retirement plan
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