JOB DETAILS POSITION SUMMARY

•Appeals and Denials Coordinator

POSITION DUTIES

•The Coordinator-Clinical Appeals is responsible for the support of the daily function and operations of the Billing and Collections department by reviewing and appealing clinical denials as well as retro authorizations. Interfaces with payors, Case Managers, Insurance Verification department, Financial Counselors, PBO, and Health Information Management department. Reviews medical records for medical necessity of admission, severity of illness, and intensity of service based on InterQual and Milliman Guidelines. Documents in appropriate systems the results of retro authorization and denial or appeal efforts. Reviews referred accounts for appropriate trauma charges, as well as NICU when requested, when charges are inconsistent. Composes and sends appeal letters to payor when denial is in violation of state and federal laws as well as due to lack of sufficient information sent to payor. Evaluates and reviews in-patient hospitalizations for delay of service and delay of discharge. Reviews all findings and appeal letters with Denial Clinical Appeals Unit (CAU) Management. Participates in department quality improvement projects. Performs other duties as needed.

MINIMUM REQUIRED QUALIFICATIONS

•Recent experience in specialty BLS California Vocational Nurse (LVN) license or Medical Terminology certification

PREFERRED QUALIFICATIONS

•Nationally recognized certification in Utilization Management, Utilization Review, Hospital Utilization, Managed Care or Health Care related area

LENGTH OF ASSIGNMENT

•22 weeks

SHIFT / HOURS PER WEEK

•8a-5p SYSTEMS•Epic

START DATE

•ASAP

BENEFITS

Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including: Medical, dental and vision benefits Earned time off and paid holidays Paid continuing education time 401(K) retirement planning Short-term disability, life insurance, paid jury duty Access to the largest network of facilities and providers in the country Industry experienced workforce management team Licensure and certification reimbursement

AREA OVERVIEW

Loma Linda, CA offers a thrilling experience for adventurous healthcare professionals. From its picturesque hills and lush greenery to its renowned hospitals and medical facilities, this city provides a unique blend of nature and healthcare opportunities. With nearby hiking trails, mountain biking routes, and outdoor adventures waiting to be explored, Loma Linda is the perfect destination for those seeking both professional growth and outdoor excitement. Explore the San Bernardino National Forest Hike the Box Springs Mountain Reserve Visit the Loma Linda University Medical Center Enjoy a relaxing day at the Loma Linda Veterans Park Attend a local farmers market for fresh produce ← Move left → Move right ↑ Move up ↓ Move down + Zoom in•Zoom out Home Jump left by 75% End Jump right by 75% Page Up Jump up by 75% Page Down Jump down by 75% Map Terrain Satellite Labels Map Data Map data ©2026 Google Map data ©2026 Google 10 km Click to toggle between metric and imperial units Terms Report a map error

ABOUT THE COMPANY

At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable. • Estimate of payments is intended for informational purposes and includes hourly wages, as well as reimbursements for meal & incidental expenses and housing expenses incurred on behalf of the Company. Please speak with a recruiter for additional details. 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