Healthcare Denials & Authorization Specialist

Tarzana Treatment Centers, Inc.; Los Angeles (CA); Sur place; USD 90 317 000 - 108 398 000; Plein temps

Avantages offerts par ce poste

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

Résumé du poste

Tarzana Treatment Centers, Inc. in Tarzana, CA is seeking a Denial Specialist responsible for managing contract patient denial status, auditing charts, and reporting on Denials while coordinating improvement activities.

The role reviews denials from County/State funding, uses SAGE and AVATAR to determine denial needs, prepares appeals, and communicates with SAPC and program staff to maximize revenue and ensure compliance.

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.

Responsabilités

• Audit denied authorizations to maximize revenue for the Drug Medi-Cal contract.
• Review ASAM assessments and relevant items in SAGE and AVATAR systems to determine denial needs.
• Review and triage denials for actions on re-authorizations with SAPC in SAGE.
• Prepare grievance/appeal language for resubmission of authorization.
• Input information into SAGE and AVATAR; coordinate with programs as needed.
• Conduct internal audits to improve compliance with SAPC and Joint Commission standards.

Connaissances

Auditing

Quality Assurance

Denial management

Healthcare compliance

Formation

Bachelor's degree or 4+ years experience

Outils

SAGE

AVATAR

SAPC

Description du poste

Tarzana Treatment Centers, Inc. in Tarzana, CA is seeking a Denial Specialist responsible for managing contract patient denial status, auditing charts, and reporting on Denials while coordinating improvement activities.

The role reviews denials from County/State funding, uses SAGE and AVATAR to determine denial needs, prepares appeals, and communicates with SAPC and program staff to maximize revenue and ensure compliance.