About the position
Chino Valley Medical Center is a 112-bed community hospital established in 1972 and centrally located in Southern California's Chino Valley. A nine-time recipient of the Healthgrades Patient Safety Excellence Award (2014-2022), Chino Valley Medical Center has been recognized nationally for its quality, including as among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. Chino Valley Medical Center is committed to serving the community's health care needs with top-rated emergency care as well as senior services, orthopedics, surgical services and more. Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community.
Responsibilities
- Coordinate the utilization review and appeals process as part of the denial management initiatives.
- Responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals.
- Document and track all communication attempts with insurance providers and health plans.
- Follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers.
- Serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned.
- Support the department needs for Release of Information, discharge coordination or other duties as assigned.
Requirements
- Bachelor's degree or four years of relevant experience required.
- Accurate alphabetic, numeric, and/or terminal-digit filing skills.
- Computer data entry with 10-key, with accurate typing speed of 35 wpm required.
- Excel skills highly preferred.
- Knowledge of terminal digit filing and medical terminology; preferred.
- Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
- Completion of a medical terminology course; preferred.
- Background in business and office training; preferred.
Benefits
- Paid Time Off
- 401K retirement plan
- Outstanding Medical, Dental, Vision Coverage
- Tuition Reimbursement
- Many more Voluntary Benefit Options
