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Appeals Denials Specialist (RN/LVN)

Universal Health Services

Job Code:
  • Insurance
  • Healthcare
  • Customer Service
  • Behavioral Health
  • Case Management
  • Clinical Specialist
  • LPN / LVN
  • Managed Care
  • Ambulatory Care
  • Risk Mgmt / UR / QA
  • Nurse Practitioner
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Job Details

Appeals Denials Specialist (RN/LVN)

Job Code:  242965
Facility: Pacific Region CBO
Location: MURRIETA, CA US Western
Region: Western
Travel Involved: None
Job Type: Full Time
Job Level:  Experienced (Non-Manager)
Minimum Education Required: High School or equivalent 
Category: Accounting/Finance,Professionals
FTE: 1.0
Position Summary:

Position Summary:

Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected health care management companies, operating through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory centers nationwide. Founded in 1978, UHS subsidiaries now have more than 65,000 employees. The UHS business strategy is to build or purchase health care properties in rapidly growing markets and create a strong franchise based on exceptional service and effective cost control. Our success comes from a responsive management style and a service philosophy based on integrity, competence and compassion


The Pacific Region CBO facility is located in Murrieta California. We are one of three Centralized Business Offices within UHS. Our CBO supports 6 UHS Hospitals. We have approximately 100 valued employees at our facility.


The Pacific Region CBO currently has a Appeals Denials Specialist position available.  The candidate selected will be responsible for the following: 

The Appeals Denials Specialist will be responsible for Managing the daily activities related to the CBO's Clinical Appeals function. The position will analyze trends and root cause issues in insurance denials and work with insurance companies to implement ways to resolve underlying reasons for denials. This position will work as a liaison between Clinical Appeals and other departments to conduct billing and charging compliance. This position will also provide clinical knowledge for CBO staff and consultation to management as needed.


The following are the job requirements for the Appeals Denials Specialist Position:

This position must have excellent organizational and assertive communication skills to articulate knowledge both verbally and in writing, have an understanding of coding and billing principles and philosophies. Be proactive, assertive, and have the ability to prioritize and multi- task. Experience working in  utilization- case management and focus or charge audits with knowledge of payer requirements pertaining to technical and clinical denials is required. Must have understanding of the Medical record and interpretation of clinical data.  Must be detail oriented. Must have the ability to work effectively with payers, case management and utilization. Must have an understanding of various audit processes pertaining to denial trends and also other regulatory agencies such as CMS, and Recovery Audit Contractors (RAC) methods.  Must be Customer focused, providing service consistently exceeding expectations to both internal and external customers. Proficiency in Microsoft Office applications (word and excel)  and others as required.

Experience in working with Patient Financial Service and an understanding of the Revenue Cycle from beginning to end is preferred. Ability to meet productivity standards set to goals by the manager of the department. RN or LVN licensure in good standing with 3-5 years of experience is preferred.



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