Reimbursement Hospital Billing Supervisor - HB Patient Financial Services

Who We Are

UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region.

Listed among America’s Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and qua ternary care and is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center.

UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.

To learn more about UCI Health, visit (Use the "Apply for this Job" box below)..

Incumbent is responsible for planning, directing and overseeing all aspects of Clinical Appeals and Charge Audits. The Clinical Appeal Nurse will be in charge of initiating the appeal process and developing victorious appeal letters to support medical necessity or level of care. Provides necessary training and education to staff involved in processes and ensures standards complies with federal, state and other regulatory agency rules and regulations.

Works with Care Management leadership and Physician Advisors to ensure knowledge of denial to improve impactful areas. Actively participates on organizational performance improvement projects. Serves as a role model and resource to colleagues, staff and others.

• Strong knowledge and understanding of ICD-10 and CPT codes
• Proficiency in Microsoft Office suite
• Outstanding interpersonal skills; ability to interact effectively at all levels of the organization
• Must possess the skill, knowledge and abilities essential to the successful performance of assigned duties
• Must demonstrate customer service skills appropriate to the job
• Knowledge of CMS, DHCS, Joint Commission, CADP, and other regulatory and compliance requirements
• Experience generating victorious Appeal Letters
• Excellent written and verbal communication skills in English
• Excellent working knowledge of desktop computer productivity tools
• Excellent analytical skills
• Demonstrated ability to lead change and effectively manage conflict
• Current CA RN license
• Bachelor of Science in Nursing
• Ability to maintain a work pace appropriate to the workload
• Ability to establish and maintain effective working relationships across the Health System
• 3 years working in an Acute Hospital Utilization Management, Concurrent Review Process or Care Management area
• 3 year experience with Inter Qual/MCG Guidelines required

• Knowledge of quality improvement methodologies
• Knowledge of patient safety strategies
• Knowledge of University and Medical Center organizations, policies, procedures and forms

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Employment Misconduct*
• Legal Right to Work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment

Exercise the utmost discretion in managing sensitive information learned in the course of performing their duties. Sensitive information includes but is not limited to employee and student records, health and patient records, financial data,…