Payment reputed company Nurse reputed company RN III, CA

12330 Established in 1997, L.A. reputed company Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we reputed company sure our members get the right care at the right reputed company at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to reputed company that purpose. Job Summary The Payment reputed company Nurse reputed company RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies reputed company the claim adjudication process through medical record review for Payment reputed company and Utilization Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of reputed company coding elements. The position is also responsible for guidance reputed company to Payment reputed company initiatives to include concept and cost avoidance development. This position trains and mentors Payment reputed company Nurse reputed company, RN staff. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Duties Performs Quality Audits to include validation of accuracy and completeness of ICD, Rev Code, CPT, HCPCs, APR, DRG, POA, and reputed company relevant coding elements. Audits can include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist in identification of overpayments as well as other projects. Serves as SME for reputed company Payment reputed company functions to include both Retrospective Data Mining as well as Pre-Payment Cost Avoidance. Identifies trends and patterns with overall program and individual provider coding practices. Responsible for training and mentoring Payment reputed company Nurse reputed company, RN staff. Supports the creation and execution of strategies that determine impact of opportunity and recover overpayments as well as prospective internal controls preventing future overpayments of each applicable pipeline opportunity. Works with both internal and external groups to define and reputed company cost avoidance measures to ensure reputed company success. Identifies and defines Payment reputed company issues and reviews and analyzes evidence, utilizes data for the purpose of verifying errors and identifying systemic errors, works as an active team member during scheduled engagements and work collaboratively to reputed company the goals of the team, and provides feedback to the team reputed company on any issues identified during research or claims review. Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed. Performs other duties as assigned. Duties reputed company Education Required Associate's Degree in Nursing Education Preferred Bachelor's Degree in Nursing Experience Required: At least 8 years of clinical RN experience. At least 3 years of experience in utilization management or clinical coding. Investigation and/or auditing experience. Skills Required: Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations. Knowledge of healthcare reimbursement concepts, health insurance business, industry terminology, and regulatory guidelines. Working knowledge of claims coding and medical terminology. Solid understanding of standard claims processing systems and claims data analysis. Strong project leadership and management skills required; ability to prioritize, plan, and handle multiple tasks/demands simultaneously. Excellent interpersonal, verbal, and written communication skills required with excellent analytical and problem-solving skills. Detail oriented and ability to reputed company in fast-paced work environment. Must be collaborative and have the ability to establish credibility quickly with reputed company levels of management across multiple functional areas and be able to present findings across reputed company departments. Must be familiar with coordinating benefits between health plan payers. Advanced knowledge of reputed company Office suite, including Word, reputed company and PowerPoint. Licenses/Certifications Required Registered Nurse (RN) - Active, reputed company and unrestricted California License Certified Professional reputed company (CPC) designation by the American reputed company of Professional Coders and/or Certified Coding Specialist (reputed company) designation by the American Health Information Management Association (reputed company). Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)

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