UCLA Health • Los Angeles, CA 90006
Job #2674812443
Description
Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health.
In this key position, you will be the primary point of contact for receiving and resolving member denials. You will review denials for accuracy, confirming the receipt of necessary documentation to support the denial and ensuring compliance with all contractual obligations and state and federal laws/regulations. You will extrapolate and summarize essential information for the UM Manager and Medical Director and regularly meet with them for clinical guidance in resolving cases. You will also document appeals in the tracking system and maintain relevant statistical data.
Salary Range: $22.03 - $43.68 HourlyQualifications
We're seeking a results-driven, quality-focused, self-motivated team player with:
High school diploma, GED or equivalent
Three or more years of managed care experience (e.g., MSO, IPA, or health plan)
In-depth knowledge of medical terminology
Understanding of the HMO referral process, eligibility verification, and health plan benefit interpretation
Strong communication, interpersonal, organizational, and multi-tasking skills
Exceptional critical thinking, analytical, and problem-solving abilities
Proven execution and follow-up skills
Computer proficiency with Microsoft Office
Ability to cope well with ambiguity and stressful situations
Ability to maintain confidentiality of patient and business records
Ability to thrive within a complex academic medical center
Ability to develop, implement, and evaluate methods and systems to improve efficiency
Ability to lead and facilitate cross-functional workgroups and other meetings
Expertise in achieving compliance with regulatory requirements
Strong service orientation
UCLA Health is a world-renowned health system with four award-winning hospitals and more than 250 community clinics throughout Southern California, as well as the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles' trusted provider of exceptional, compassionate patient care. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.
UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person's unique achievements and experiences to further set us apart.
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