Are you ready to bring your expert clinical skills to a world-class facility recognized as one of the top ten in the United States? Do you have a passion for the highest quality and patient happiness? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.
When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters. This shared culture of happiness, passion and dedication pulses through Cedars-Sinai, and it's just one of the many reasons we've achieved our fifth consecutive Magnet designation for nursing excellence. From working with a team of dedicated healthcare professionals to using state-of-the-art facilities, you'll have everything needed to do something incredible--for yourself, and for others. Join us, and discover why U.S. News & World Report has named us one of America's Best Hospitals.
As a Denials Management Program Coordinator, you will be responsible for overall management and communication of clinically based appeals between Cedars-Sinai and outside payers. You will also act as a liaison and point of contact to/for division and other internal representatives for denial and appeal inquiries. In addition, you will actively manage, maintain and communicate to the Manager regarding trends, and recommended corrective action plans.
Supports Manager in the response process for the organization on all government audits.
Writes reviews and ensures responses are complete and delivered in a timely manner. These include responses to all applicable entities.
Reviews non-government denials and determines appropriateness of denial based upon applicable guidelines, professional judgment, and/or community standards and responds as per department policy.
Identification and facilitation of educational opportunities with other departments, providers, and payers to decrease denials and improve quality of service to patients.
Conduct informal and formal education programs within the organization.
Works in collaboration with internal contacts and health plans to develop corrective action plans to address identified trends in reasons for denials.
Utilizes electronic database to track reasons for denial, result of denial review as it relates to ability to appeal, date of appeal actions, outcome of appeal if appropriate.
Performs case management review of issues related to compliance with government payer coverage issues as well as commercial denials.
Provides oversight of the patient classification programs, including but not limited to the pre-procedure review program and applicable vendors, and engagement.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research... and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.