REIMBURSEMENT HC ANALYST 4 -PATIENT FINANCIAL SERVICES - FT DAYS

Job description



REIMBURSEMENT HC ANALYST 4 -PATIENT FINANCIAL SERVICES - FT DAYS


Updated: Jun 10, 2021
Location: Orange
Job Type:
Department: Patient Financial Services

Job Description:

UC Title: REIMB HC ANL 4

Reports to: Reimbursement HC Supervisor 2

Cost Center: Patient Financial Services (428550)

FLSA: Exempt

Job Code: 006768

Shift: Not Applicable

Position Number: 40308790

Working Title: Reimbursement HC Analyst 4

Bargaining Unit: No Bargaining Unit

Date Created: 6/04/2021

Hours: 40

FTE: 1

Position Summary:

The incumbent is responsible to perform review of denied claims, conducting medical records reviews with use of standardized medical review software, determining claim appealability and initiates formal written or verbal appeals with various health plans. Must have knowledge of medical terminology, various health plan products (Medicare, Medi-Cal, HMO, PPO, Managed Care, etc.) private insurance and CMS guidelines. Previous experience substantiating appeals for Trauma, Acute and Psychiatric services. Also responsible for conducting external charge defense audits requested by insurance companies in collaborating with various audit firms for the conclusion of audits. Performs additional related duties, as assigned.

Salary Range:

Minimum Midpoint Maximum

Annual Rate $69900 $106400 $143000

Required Qualifications:

  • Ability to establish and maintain effective working relationships across the Health System
  • Ability to maintain a work pace appropriate to the workload
  • Must demonstrate customer service skills appropriate to the job
  • Excellent written and verbal communication skills in English
  • Competent knowledge and experience with Microsoft Office computer applications, i.e. Word, Excel
  • Three years' experience working in clinical denial review and/or clinical appeal processing
  • Three years of related clinical experience in an acute care setting
  • Five years of internal and/or external audit experience
  • Familiarity of audit software packages
  • Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
  • Must possess a current California RN license
  • Knowledge of Interqual


Preferred Qualifications:
  • Knowledge of University and medical center organizations, policies, procedures and forms




To apply, visit https://careersucirvine.ttcportals.com/jobs/6939192-reimbursement-hc-analyst-4-patient-financial-services-ft-days





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Job No:
Posted: 6/11/2021
Application Due: 6/11/2033
Work Type: Full Time
Salary: