The Revenue Integrity Clinical Denial Manager is responsible for:Â Oversight of recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review. Preparing and documenting winning appeals based on industry accepted criteria. The position will also include serving as a resource to non-clinical personnel, sound solutions related to process improvement. Assist in development of policy and procedures as business needs dictate and assist legal support with any medical necessity reviews as capacity allows up to and including attending mediation hearings, other litigation forums, etc. The position will manage and own all RAC, ADRs and all government appeals, denials management, and all associated leadership reporting. The position will also be responsible for monitoring productivity, quality, and performance of the RAC and office coordinators.
Minimum Education:-Registered Nurse or Bachelorâs Degree in Nursing.-Juris Doctor specializing in healthcare preferred.Minimum Experience/Knowledge:-Minimum of five yearsâ recent acute care experience with medical-surgical/critical care preferred.-Utilization and/or Case Management experience recommended.-Comprehensive knowledge and application of InterQualÂ® preferred.-Excellent written and oral skills required.Required License/Certification:-Current, valid RN licensure.-Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) preferred.-Fire and Safety Certification. If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date.
USC’s Viterbi School of Engineering has been one of the economic engines in Southern California and a vital hub in the California economy. The technical innovations and ideas generated by the Viterbi faculty and research community have resulted in countless innovations, many becoming the foundations for new companies, products and services. The thousands of students graduating each year bring new ideas and vitality to companies in California and beyond. With an annual research budget exceeding $205M each year, more than 46 research centers and institutes, more than 180 faculty members, 7,800 students and over 60,000 impassioned alumni world-wide, the Viterbi School is addressing some of the world’s great challenges.