Primary Duties and Responsibilities
Make a positive impact on one of the nation’s top health systems. Help ensure the efficient delivery of award-winning patient care. Take your professional expertise to the next level. UCan do all this and more at UCLA Health.
You will become a member of our highly successful Clinical Documentation Integrity and Denial Management team, including all modalities. This role involves daily review of high-acuity patient records to identify potential and active payer denials, assess clinical validity, and to support denial prevention, analysis, and appeals across inpatient and outpatient settings; continuously communicating with department staff; educating physicians, residents, and mid-levels; and assisting with appropriate documentation strategies.
Partnering with Medical Coding, Clinical Documentation Integrity, Case Management, and the Quality team, you will gather/analyze information to provide comprehensive medical record documentation that accurately reflects clinical treatment, decisions, and diagnoses. Leveraging your denial management experience, clinical expertise, and coding knowledge to identify opportunities and ensure accuracy and completeness of clinical documentation for denial prevention. You will prepare and submit high quality appeal letters supported by clinical evidence, regulatory guidelines, and payor-specific medical necessity criteria, while identifying denial trends and root causes and provide feedback to the CDI and Clinical teams.
Salary Range: $100,161.36 - $218,718.00/year
Job Qualifications
We’re seeking a detail-oriented, collaborative, self-directed individual with:
· Bachelor’s degree in health-related field, preferred
· A Registered Nurse (RN) license or MD diploma (or equivalent) required
· Three or more years of Clinical Documentation Integrity experience required, preferably at an AMC
· Knowledge of coding guidelines and coding clinic, required
· Knowledge of laws, rules and regulations regarding appropriate clinical documentation for Medicare, Medi-Cal, CCS etc.
· Strong leadership, supervisory, and training skills
· Excellent critical thinking abilities
· Experience working within EPIC and 3M 360 Encompass CAC, required
· Resourcefulness and strong communication, organizational, and analytical skills
· Ability to work effectively with physician/staff and interdisciplinary teams
· Computer proficiency and proficiency in Word, Excel and PowerPoint, required
· Skill in abstracting/interpreting medical information from patient records, required
· Clinical experience sufficient to understand and communicate medical diagnoses and courses of treatment to professional and non-professional personnel, required
· Knowledge of computer word processing, database programs, and ability to write reports and do graphical analysis, required
Note: Skills may be subject to test.
Job Qualifications
As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
Current/former UC employees are subject to a personnel file review.
RN or MD required, 3+ years CDI experience, coding and regulatory knowledge, EPIC and 3M 360 Encompass CAC experience, Microsoft Word/Excel/PowerPoint proficiency, strong communication and analytical skills.
Key Responsibilities
- reviewing records
- preventing denials
- preparing appeals
Skills & Tools
EPIC, 3M 360 Encompass CAC, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Job Details
- Category: Healthcare Services - Advanced Practice
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — Los Angeles, California, United States
- Salary: USD 100,161 – 218,718 / year
- Languages: English
About UCLA Health
A large academic health system providing clinical care and support services. — Industry: Healthcare