Sioux Falls, South Dakota, South Dakota
Chapel Hill, North Carolina
Posted: 14-Dec-24
Location: Los Angeles, California
Categories:
Internal Number: 145209334
- 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.
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
