Denials & Revenue Integrity Analyst

Tarzana Treatment Centers, Inc; Los Angeles (CA); On-site; USD 66,000 - 79,000; Full time

Benefits offered by this job

Medical Insurance

Vision Care Plan

Life Insurance

Paid Holidays

Flexible Spending Account (FSA)

Paid Vacation Time

Sick Time

401(k) Retirement Plan

Competitive wages

Stability and career advancement

Continuing Education Opportunities

Job summary

Tarzana Treatment Centers, Inc. is seeking a Denial Specialist in Tarzana, CA to manage contract denials, perform chart audits, and drive data-driven improvements across the QA function.

The role reports to the QA Supervisor and requires a Bachelor's degree with healthcare auditing experience. The position supports standard denials processing, appeals, and documentation accuracy to maximize program revenue.

Qualifications

• Bachelor's degree or equivalent of at least 4 years experience.
• Prior experience in auditing and/or quality assurance in a healthcare setting.
• Knowledge of Los Angeles Department of Public Health, Department of Mental Health and Joint Commission standards preferred.

Responsibilities

• Reviews and reconciles denied authorizations from County and State funding sources and communicates with program staff to reverse denials to maximize revenue for the Drug Medi-Cal contract.
• Reviews ASAM assessments and relevant items in the SAGE and AVATAR systems to determine appropriate patient denial needs.
• Reviews and triages denials to determine course of action for denied initial and re-authorizations with SAPC in SAGE (Authorization Form in SAGE and Misc. Note in SAGE) for all levels of care.
• Review and determine authorization resubmission, grievance/appeal completion, or write off for denied authorizations.
• Prepares grievance/appeal language for resubmission of authorization.
• Communicates with programs to identify missing documentation upon SAPC request and correspond with SAPC regarding ongoing denials as needed.
• Reviews appropriate reports for denial updates and communicates with programs about denial status, as necessary.
• Requests program transfers and discharges to align with authorizations, as necessary.
• Inputs information into both SAGE and AVATAR systems as required for authorization needs. Communicates that information as needed.
• Works to automate the review, processing and reporting of denials throughout the organization.
• Acts as an expert on the denial process for the organization.
• Works with program staff to review admission and other relevant workflows to improve denial process and increase approvals.
• Attends trainings on authorization and denial processes and communicates findings throughout the organization, as necessary.
• Conduct regular internal audits to identify trends and areas of development to increase compliance with SAPC and Joint Commission standards.
• Audit the content of clinical documentation such as assessments, treatment plans, and progress notes for quality, liabilities, and denial risks for both public and private funding sources.
• Performs other related duties as assigned by CEO, Director of Information Technology or QA Supervisor.

Skills

Denials management

Auditing

Healthcare QA

Regulatory compliance

Education

Bachelor's degree or equivalent

Tools

SAGE

AVATAR

Job description

Tarzana Treatment Centers, Inc. is seeking a Denial Specialist in Tarzana, CA to manage contract denials, perform chart audits, and drive data-driven improvements across the QA function.

The role reports to the QA Supervisor and requires a Bachelor's degree with healthcare auditing experience. The position supports standard denials processing, appeals, and documentation accuracy to maximize program revenue.