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


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