Academy of Managed Care Pharmacy
Senior Appeals & Grievances Analyst
Academy of Managed Care Pharmacy, Los Angeles, California, United States, 90079
Description
As the Senior Appeals and Grievances Analyst, you will be responsible for: Assisting with all operational aspects of appeals and grievances, in accordance with state and federal regulations. Assisting the unit Supervisor in overseeing the appeals and grievances process, ensuring that members and providers receive fair and accurate resolutions to their concerns, and handled in accordance with all regulatory requirements. Collaborating with other organizational stakeholders, including other Appeals & Grievances team members, additional business units within UCLA Health, and external partners/vendors. Analyze, investigate, and process appeals and grievances in accordance with CMS/Medicare regulations and guidelines. Salary Range:
$38.12 - $52.33/hourly Qualifications
We’re seeking a detail-oriented, self-directed individual with: Healthcare experience preferred or another related field, required. Three or more years of direct appeals and grievances experience in a Medicare or Managed Care setting, required. Strong familiarity with benefits, enrollment/disenrollment, marketing, utilization management, required. Knowledge of Medicare and CMS regulations, specifically pertaining to appeals and grievances, required. Strong knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, as well as Revenue and HCPCS coding. Working knowledge of Microsoft Office Suite (ie. Word and Excel), and Visio and data visualization tools, required.
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As the Senior Appeals and Grievances Analyst, you will be responsible for: Assisting with all operational aspects of appeals and grievances, in accordance with state and federal regulations. Assisting the unit Supervisor in overseeing the appeals and grievances process, ensuring that members and providers receive fair and accurate resolutions to their concerns, and handled in accordance with all regulatory requirements. Collaborating with other organizational stakeholders, including other Appeals & Grievances team members, additional business units within UCLA Health, and external partners/vendors. Analyze, investigate, and process appeals and grievances in accordance with CMS/Medicare regulations and guidelines. Salary Range:
$38.12 - $52.33/hourly Qualifications
We’re seeking a detail-oriented, self-directed individual with: Healthcare experience preferred or another related field, required. Three or more years of direct appeals and grievances experience in a Medicare or Managed Care setting, required. Strong familiarity with benefits, enrollment/disenrollment, marketing, utilization management, required. Knowledge of Medicare and CMS regulations, specifically pertaining to appeals and grievances, required. Strong knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, as well as Revenue and HCPCS coding. Working knowledge of Microsoft Office Suite (ie. Word and Excel), and Visio and data visualization tools, required.
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