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Childrens Hospital of Los Angeles - Denial/Defense Auditor Nurse


Location: Glendale, California - United States
Posted: 3/11/2018

Job Description:

Give your career the best treatment.
Ready to be part of the first and largest pediatric hospital in Southern California? This is Children's Hospital Los Angeles. A place where you can make a real difference in the lives of our patients and their families. A big responsibility? Absolutely. But if you’re up for the challenge, we’re on the lookout for amazing professionals to join our elite teams – talented individuals who can continue our high level of care.

The Nurse Auditor is responsible for the management and review of all clinically based appeals to payers and Managed Care defense audits. Reviews electronic medical records to ensure sufficient documentation by clinicians, and appropriate billing/coding for denied days and medical necessity.  Prepares clinical appeals documentation for all payer types.  Applies appropriate clinical judgement during review of denied days and medical necessity to assess whether denial can be appealed.  Collaborates with physicians and leadership to enhance denial management and improve clinical documentation improvement efforts. 

Minimum Education:

Bachelor's Degree in Nursing required.  Medical coding certificate desired.

Minimum Experience: 

5-7 years of clinical nursing experience required.  Experience in case management/utilization management preferred. 

License, Registration or Certification required:

Current CA RN required.

Knowledge Skills and Abilities Required: 

Knowledge of CPT and ICD-9/10.  Knowledge of hospital revenue cycle. Knowledge of insurance contract rates and terms.  Understanding of collections process.  Understanding of CMS billing and payment rules.  

Additional Requirments / Information

Job Capacity:Employee (full-time)
Minimum Education Level:See Job Description
Visa Sponsorship: No
Related Industries:Other

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