DENIALS APPEALS SPECIALIST, PIH HEALTH GOOD SAMARITAN HOSPITAL, LOS ANGELES, FULL TIME, DAYSApply Now Job ID 9315-977 Date posted 03/26/2020
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services
Works under the supervision of the Billing and Collection Supervisor. The Denials & Appeals Specialist is responsible for appealing denied claims. Must effectively interact with multiple disciplines including Patient Access, HIM, Charge Description Master, Contract Management, physicians, private insurance and government agencies. Demonstrates self-direction, professionalism, effective communication skills, a working knowledge of denials and an expertise in understanding private and governmental regulations as it applies to hospital services. Analyzes and interprets Managed Care contract language, terms, conditions and responsibility matrices. Is knowledgeable with the use of appropriate HCPCS, CPT 4 codes, Modifiers, ICD9 and ICD10 codes. Has the knowledge of insurance billing rules and regulations. Has the ability to utilize multiple hospital systems. Performs other duties as needed.
- Knowledge of payer specific regulatory and contractual obligations
- Knowledge of State insurance regulations related to medical claims payment
- Strong verbal and written communication skills
- Critical thinking skills
- Problem solving skills
- Knowledgeable with AB774 regulations
- High school graduate. Associate's Degree or higher preferred.
- LA City Fire Card within 6 months of employment.
- Previous experience working in an acute hospital patient account setting required.
- Minimum of four years’ experience in hospital Patient Accounting including, billing, collections, insurance authorization, denials and written appeal experience required.
The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.