University of California - Los Angeles Health
Appeals and Grievances Analyst
University of California - Los Angeles Health, Los Angeles, California, United States, 90079
Description As the Appeals and Grievances (A&G) Analyst, you will be responsible for assisting with all operational aspects of appeals and grievances, in accordance with state and federal regulations. You will:
Manage various weekly/monthly deadlines effectively due to the time constraints imposed by CMS on Medicare appeals and grievances. Collaborates closely with beneficiaries, healthcare providers, and insurance companies to ensure that complaints, appeals, and grievances are addressed in a timely manner. Analyze and process appeals and grievances in accordance with CMS/Medicare regulations and guidelines. Investigate complaints and work with all parties involved to find a resolution in accordance with CMS/Medicare regulations and guidelines. Salary: $31.45 - $43.17/hourly
Qualifications
We're seeking a detail-oriented, self-directed individual with: Three or more years of experience in a Medicare or Managed Care, specifically benefits, enrollment/disenrollment & grievances and appeals process, required Knowledge of Medicare and CMS regulations, required Strong knowledge of the health care model and other managed care MSO operations, required Strong familiarity with CMS requirements and regulations pertaining to appeals and grievances Knowledgeable 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 (i.e., Word and Excel), and Visio and data visualization tools, required
Reliability and compliance with scheduling standards
Strong ability to research and resolve issues
#J-18808-Ljbffr
Manage various weekly/monthly deadlines effectively due to the time constraints imposed by CMS on Medicare appeals and grievances. Collaborates closely with beneficiaries, healthcare providers, and insurance companies to ensure that complaints, appeals, and grievances are addressed in a timely manner. Analyze and process appeals and grievances in accordance with CMS/Medicare regulations and guidelines. Investigate complaints and work with all parties involved to find a resolution in accordance with CMS/Medicare regulations and guidelines. Salary: $31.45 - $43.17/hourly
Qualifications
We're seeking a detail-oriented, self-directed individual with: Three or more years of experience in a Medicare or Managed Care, specifically benefits, enrollment/disenrollment & grievances and appeals process, required Knowledge of Medicare and CMS regulations, required Strong knowledge of the health care model and other managed care MSO operations, required Strong familiarity with CMS requirements and regulations pertaining to appeals and grievances Knowledgeable 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 (i.e., Word and Excel), and Visio and data visualization tools, required
Reliability and compliance with scheduling standards
Strong ability to research and resolve issues
#J-18808-Ljbffr