PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women's health, urgent care and emergency services
Works under the supervision of the Billing and Collection Supervisor. The Denials & Appeals Specialist is responsible for appealing denied claims. Must effectively interact with multiple disciplines including Patient Access, HIM, Charge Description Master, Contract Management, physicians, private insurance and government agencies. Demonstrates self-direction, professionalism, effective communication skills, a working knowledge of denials and an expertise in understanding private and governmental regulations as it applies to hospital services. Analyzes and interprets Managed Care contract language, terms, conditions and responsibility matrices. Is knowledgeable with the use of appropriate HCPCS, CPT 4 codes, Modifiers, ICD9 and ICD10 codes. Has the knowledge of insurance billing rules and regulations. Has the ability to utilize multiple hospital systems. Performs other duties as needed.
The organization is recognized by Watson Health as one of the nation's Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation's top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.