Clinical Denials Consultant
The Informatics Group - Los Angeles, CA

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Role: Clinical Denials Consultant

The Informatics Group is looking for a Clinical Denials Consultant to support the Revenue Cycle department. The Clinical Denials Consultant will work under the day to day direction of the Revenue Cycle Director.

This position is responsible for day to day review, coordination and management of clinical denials and requires a clinical background and understanding from a provider operational and payer logistical perspective.

The successful candidate will work closely with the Technical Denial Consultants, Coders, Insurance companies, Physicians and support staff to review, prepare appeals and monitor outcomes of appeal activities.

Minimum Position Qualifications:
Required Experience-

  • Registered Nurse or LPN
  • 5 years of healthcare experience in clinical practice setting
  • Strong clinical background, with experience in case management preferred. Ability to apply clinical criteria and guidelines and understanding of benefits administration in a payer setting preferred.
  • Experience with charge masters and coding
  • Proven ability in working with clinical denials
  • Assist in developing clinical denial workflows and processes
  • Excellent verbal and written communication skills
  • Exceptional customer service skills
  • Excellent computer skills, experience using Word, Excel, Outlook
  • Strong ability to record and document information to meet risk, regulatory and accreditation requirements
  • Strong managerial and organizational skills and ability to present clinical information to physicians
Training: Excellent knowledge of applicable rules/regulations/guidelines governing Managed Care and Government sponsored coverage and reimbursement.

  • Completion of a medical terminology class or equivalent experience. Certified coder preferred.
  • RN or LPN
  • This will be 100% on-site.
This position will have an immediate date and 6 mo+ initial contract. Potential of contract to hire.

All qualified candidates will be contacted within 48 business hours for an initial phone interview and to discuss these opportunities further.

Send your resume to:
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The Informatics Group Inc. is a Healthcare IT Consulting Company. Our consultants provide their expertise to Healthcare organizations.

We are not your typical IT shop. Our only focus is providing staff exclusively to Healthcare Systems, Institutions, Clinics and Physician Practices.

We are looking to immediately employ consultants for multiple opportunities across the US. Most of these positions are traveling roles and you can live anywhere and travel to client sites weekly. Typically, work weeks are Monday thru Thursday. As an employee of The Informatics Group, you will have available to you competitive pay, health benefits, 401k, Travel Expense Reimbursement, and full resources for you to continue to grow your career.