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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.

Qualifications:

Education:

• Graduate of an accredited nursing program required

• BSN preferred

License/Certification:

• Current, unrestricted California RN License required

• BLS from the American Heart Association required

• Case Management certification (CCM or ACM) required or willing to obtain within one year from start date

Experience:

• A minimum of 1 year of acute care nursing experience required

• Experience in ER, Telemetry, ICU or Cath Lab preferred

• 6 months of case management experience preferred

• Proficiency using a PC in a Windows environment required

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

• Working Title: Denials Management Program Coordinator Per Diem
• Department: Dir Compliance/Revenue Mgt
• Business Entity: Corporate Services
• City: Los Angeles
• Job Category: Patient Financial Services
• Job Specialty: Revenue Integrity
• Position Type: Per Diem
• Shift Length: 8 hour shift
• Shift Type: Day