Medical Denials and Appeals Specialist

Los Angeles, CA 90017

Employment Type: Temporary Category: Healthcare Job Number: TD-LA-DenialAppealsMgr01 Pay Rate: $23-$26 per hour

Job Description

A well-known hospital in the Los Angeles area is looking for a qualified Denial and Appeal Specialist.

The Denial and Appeal Specialist is responsible for managing denied claims and submitting appeals to the appropriate carrier while abiding by hospital policies and regulations.

The ideal candidate will have 4+ years’ experience in a billing or collections role in a hospital. They will also be an expert on private and government regulations that are applied to hospitals and hospital services.

Our client is a world renowned, academic medical center in the heart of Los Angeles. Known for their Heart and Vascular experts, award-winning obstetrics, advanced Perinatal and Orthopedics departments as well as MANY other leading-edge divisions, they offer an exciting and dynamic place to work. This position is an amazing opportunity to grow with a team of caring and talented professionals who provide quality and innovative care to patients around the world.

Career Strategies Inc is a national staffing firm that provides temporary and direct hire staffing services to outstanding firms located throughout the United States. For over 30 years, we have helped thousands of talented candidates find fulfilling careers in a variety of industries including technology, entertainment, marketing, real estate, finance and accounting.

Job Duties:

  • Denials management
  • Reviewing clinically denied cases
  • Prioritize cases depending on appeals
  • Collaborate with claims managers
  • Contact physician/office staff to retrieve patient information
  • Perform reports and audits
  • Act as an additional resource and payor contact
  • Schedule, coordinate and collaborate with implementation software
  • Process update for software when needed
  • Provide first-line assistance for claims
  • Resolve problems and coordinate resolutions for cases
  • Interact with various insurance companies and online billing platforms
  • Special projects, as requested
  • This is not a comprehensive list of duties

Job Requirements

  • 3+ years' of experience in a billing/collections role (MUST)
  • 3+ years’ of managing denials and claims process (MUST)
  • 1+ years’ of experience using various hospital accounting systems (MUST)
  • 1+ years’ experience working with  private and governmental regulations (MUST)
  • Knowledge of the appropriate use of HCPCS, CPT 4 codes ICD9 (MUST)
  • Knowledge of insurance billing rules and regulations (MUST)
  • Advanced computer/software skills: Outlook/Word/Excel/Powerpoint (MUST)
  • Desired Personality Traits and Advanced Skills: ability to write clearly and concisely, strong interpersonal communication, ability to anticipate needs and problems, analyze and prioritize issues, attention to detail, organized, conflict/problem resolution, effective written and verbal communication, unwavering integrity, confidentiality, discretion

See more healthcare administration opportunities with Career Strategies' clients at www.csi4jobs.com!

Additional Information

Equal Opportunity Employer considering qualified candidates in accordance with state and federal laws, including those with criminal histories, in a manner consistent with the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance.

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