Denials Coordinator

Position Summary:
The denial coordinator is responsible for being the “first line” resource for preparing and maintaining health plan criteria for the campus Medical Directors. This includes collaborating with each Health Plan to obtain updated/adequate criteria for each specialty to ensure that appropriate criteria are referenced upon furnishing a denial. This includes questions regarding procedures, training, and processes to assure compliance with RMG/LMG policies and procedures. The denial coordinator assists the campus Regional Medical Directors and Inpatient Manager/Supervisor with daily operations and management of denials, training, auditing functions, and assuring that all staff provides a level of patient service that meets or exceeds the organization's expectations.

Essential Duties and Responsibilities include the following:

- Understand all aspects of the functionality of Access Express/Heritage Connect with respect to prior authorization and the customer service modules.
- Complete assigned tasks accurately and within specified time limits.
- Maintain smooth working relations with co-workers and supervisors. Be a “Team Player”
- Anticipate future events, set realistic goals, timetables, coordinate activities to ensure smooth work flow and time management
- Understand all Regal Medical Management policies and procedures to help create and maintain job aids that are consistent with these policies.
- Communicate effectively and interact with the department managers, compliance officer, regional medical directors and staff daily or as indicated regarding all medical management processes.
- Identify and schedule ongoing training sessions for established staff to review processes with the department trainer where deficiencies appear in audits.
- Help to train new nurses, physicians, medical directors, and necessary staff to rapidly learn the Organizations principles of Medical Management and to facilitate the right care at the right time in the right setting.
- Verify that patient confidentiality is maintained by the staff and that HIPPAA compliance is observed at all times.
- Treat co-workers and customers with patience and respect.
- Arrive to work on time. Consistently be at work. Display flexibility regarding lunches, breaks and work
- Anticipate our provider's needs: Understand their wants and needs, listen for cues and identify how to respond and what level of intervention they need.
- Returns phone calls to providers and follow up with requests in a timely fashion, as necessary with regards to tasks at hand.
- Demonstrates honesty and integrity in everyday activities.
- Recognizes when an error has been made and immediately correct it then report to appropriate manager.
- Interacts professionally with other healthcare service providers.
- Communicates appropriately and clearly to management, co-workers, and physicians.
- Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs.
- Maintains quality monitors as assigned by Management.
- Performs other duties as assigned
- Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
- All other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $23 - $25 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 organi