Denials Management Specialist Hybrid $2,000 Sign on Bonus
3 weeks ago
DUTIES AND RESPONSIBILITIES
- 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
SKILLS & ABILITIES REQUIREMENTS:
- 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.
REQUIREMENTS
EDUCATION / EXPERIENCE
- High School Diploma or equivalent, some college coursework preferred
- 3 - 5 year experience in a hospital business environment performing billing and/or collections
-
Denials Manager
7 days ago
Anaheim, United States Ahmc Healthcare Inc. Full timeOverview The Denials Manager appeals all denials using InterQual criteria. Evaluates, tracks and trends denials and implements denial prevention programs. Works closely with Case Managers, Physicians and multidisciplinary team to ensure compliance with documentation and educates as needed. The position requires the full understanding and active...
-
Denials Manager
2 weeks ago
Anaheim, United States AHMC Healthcare Full timeOverview: The Denials Manager appeals all denials using InterQual criteria. Evaluates, tracks and trends denials and implements denial prevention programs. Works closely with Case Managers, Physicians and multidisciplinary team to ensure compliance with documentation and educates as needed. The position requires the full understanding and active...
-
Patient Account Specialist I
2 weeks ago
Anaheim, United States KPC GLOBAL MEDICAL CENTERS INC. Full timeJob DescriptionJob DescriptionHybrid $3,000 Sign-on BonusPatient 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), EPO's, International Payers, Auto Liability and other...
-
Denials Manager
2 weeks ago
Anaheim, California, United States AHMC Healthcare Full timeOverview: The Denials Manager appeals all denials using InterQual criteria. Evaluates, tracks and trends denials and implements denial prevention programs. Works closely with Case Managers, Physicians and multidisciplinary team to ensure compliance with documentation and educates as needed. The position requires the full understanding and active...
-
Patient Account Specialist II
2 weeks ago
Anaheim, United States KPC GLOBAL MEDICAL CENTERS INC. Full timeJob DescriptionJob DescriptionHybrid $3,000 Sign-on BonusPerforms account follow up from third-party payers including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), EPO's, International Payers, Auto Liability and other Liability carriers, and all other non-governmental...
-
RN - ER Nurse Manager - $15,000 Sign-On Bonus
4 weeks ago
Anaheim, United States Advenio Medical Staffing Full time$15,000 SIGN-ON BONUS - Excellent Nurse Manager opportunity for a Registered Nurse with ER experience. This is a full-time evening shift position. Qualifications: Must have a BSN and an active CA RN license (or license in process). Preferred experience as an ER Manager specifically within a Trauma, Stroke, STEMI ER environment. Minimum of three years...
-
Case Management Assistant
5 days ago
Anaheim, United States AHMC Healthcare Full timeOverview: The Case Management Assistant is responsible for providing administrative and clerical support for the Case Management/Utilization Management team; with an emphasis on Case Management, Discharge Planning, Utilization Management, Resource Management and Social Services. The functions of Case Management Assistant is to use effective interpersonal...
-
Customer Service Specialist
6 days ago
Anaheim, United States Todd Allstate Insurance Full timeJob DescriptionJob DescriptionTodd Allstate Insurance, located in the heart of Anaheim, California, is seeking a Customer Service Specialist to join our dedicated team. With a strong focus on providing exceptional service to our clients, we take pride in our commitment to excellence and integrity.We are looking for a proactive individual who is passionate...
-
OHS Medical Biller
3 weeks ago
Anaheim, United States Anaheim Admin Full timePlanned Parenthood of Orange and San Bernardino Counties has a full-time hybrid (3 days in office) opportunity for a OHS Medical Biller in Anaheim, CA.Assures timely eligibility for appointments, working with OHS dashboard, billing and reimbursement of clean claims, corrects denied claims, appeals denied or delayed claims for OHS payers in order to receive...
-
Anaheim, United States Todd Allstate Insurance Full timeJob DescriptionJob DescriptionTodd Allstate Insurance, located in the heart of Anaheim, California, is seeking a Customer Service Specialist to join our dedicated team. With a strong focus on providing exceptional service to our clients, we take pride in our commitment to excellence and integrity.We are looking for a proactive individual who is passionate...
-
Management Assistant
3 weeks ago
Anaheim, United States PM2CM Full timeJob DescriptionJob DescriptionThe position is based in Pomona with two days (Tuesday and Wednesday) working at the office. Company Overview:PM2CM, Inc., is a professional services company dedicated to providing Program, Project and Construction Management, Scheduling, Cost Controls and Claims avoidance and Mitigation services to our clients. Our goal is...
-
Chief Financial Officer
7 days ago
Anaheim, United States Affinity Executive Search Full timeOur client is an IT consulting firm that focuses on the Financial Services marketplace. (Payments, Mortgages & Lending, and Capital Markets, including Hedge Funds, Private Equity, Real Estate, Wealth & Asset Management etc....) They currently have over 2,000 employees worldwide and are in need of a CFO to lead their operation based out of Anaheim...
-
Outpatient Psychiatrist
7 days ago
Anaheim, United States LifeStance Health Full timeWe are actively seeking a part-time (10 hours and up) or full-time (30 hours or more) Adult or Child & Adolescent Psychiatrist to join our group in California. While working with us, you will have the ability to treat the way you want to treat. Psychiatrists with us have the opportunity to do as much or as little psychotherapy as they...
-
Outpatient Psychiatrist
6 days ago
Anaheim, United States LifeStance Health Full timeWe are actively seeking a part-time (10 hours and up) or full-time (30 hours or more) Adult or Child & Adolescent Psychiatrist to join our group in California. While working with us, you will have the ability to treat the way you want to treat. Psychiatrists with us have the opportunity to do as much or as little psychotherapy as they...
-
Outpatient Psychiatrist
3 days ago
Anaheim, United States LifeStance Health, Inc. Full timeJob DescriptionWhat we offer Psychiatrists Competitive compensation package based on productivity with uncapped earning potential Comp range of $360,000 to $420,000Sign-on bonusClinician Long Term Incentive ProgramComprehensive benefits package401K with 4% matchPart-time and full-time optionsYearly funds towards association or license duesCME allowancePaid...
-
Jr Level Marketing Specialist
3 weeks ago
Anaheim, United States Eclipse California Full timeOur ever-evolving team will be adding a fresh and innovative Jr Level Marketing Specialist to our Management Department. The Jr Level Marketing Specialist that we select to join us will gain a full understanding of every department within our firm with the help of intensive training provided by our management staff. As a Jr Level Marketing Specialist, you...
-
Client Implementation Specialist
4 weeks ago
Anaheim, United States InfoSend Inc Full timeJob DescriptionJob DescriptionDescription:Job description***REMOTE POSITION ONLY IN: CA, AZ, TX, IL, FL, GA, UT, OR, MI and NV. OTHER STATES WILL NOT BE CONSIDERED***Get to Know UsInfoSend has been a trusted provider of cutting-edge eBilling, ePayment, Data Processing, BillPrint & Mail services since 1996. Our services are designed to help organizations...
-
Anaheim, United States HealthCare Connections Inc Full timeLos Angeles, CALIFORNIA Primary Care: Adults Only Diverse non-profit in Los Angeles, California is actively recruiting a Family or Internal Medicine MD/DO to see adults only in a 100% outpatient practice boasting a Monday-Friday 8-4:30 schedule. For over 50 years, this organization has been providing care based on the philosophy that healthcare is a RIGHT...
-
Sterile Processing Tech II
3 weeks ago
Anaheim, United States Kaiser Permanente Full timeDescription: $2,000 sign on bonus eligible position!Decontaminates, cleans, packages, sterilizes, stores and distributes medical / surgical, equipment and supplies in accordance with CDC, OSHA, EPA, AAMI, Title 22, APIC, SGNA, JC guidelines as required.Essential Functions:• Responsible for filling orders from requesting departments.• Make equipment...
-
Inventory Control Specialist
7 hours ago
Anaheim, United States Lumicity Full timeInventory Control Specialist | Oil & Gas | Anaheim, CA (On-Site)My client in the Oil & Gas industry are seeking a talented Inventory Control Specialist to join their team. The Inventory Control Specialist will play a critical role in managing and optimizing my client's inventory processes. This position is responsible for maintaining accurate inventory...