California Licensed Clinical Denials Analyst

Job Summary

Focused on reducing clinical and documentation-related denials, the full-time California Licensed Clinical Denials Analyst will analyze denial data, collaborate with cross-functional teams, and develop prevention strategies while working remotely.

Key responsibilities

• Analyze denial and write-off data to identify patterns and prevention opportunities across clinical and revenue cycle processes
• Conduct denial reviews and collaborate with various teams to address documentation and workflow gaps
• Lead root-cause analyses and develop remediation strategies, monitoring their effectiveness through KPI reporting

Required qualifications

• Bachelor's Degree (BSN) is highly preferred; Diploma or Associate's Degree in Nursing accepted with significant experience
• Minimum of five years in nursing, with at least two years in Utilization Management in an acute care setting
• Experience with denial prevention and related responsibilities within a healthcare setting
• Strong understanding of ICD-10-CM/PCS, CPT/HCPCS coding, and medical necessity guidelines
• Valid California Registered Nurse license required upon hire