Presque Isle, Maine
Durham, North Carolina
Ellsworth, Maine
Stony Brook, New York
Los Angeles, California
Posted: 14-Nov-24
Location: Los Angeles, California
Categories:
Internal Number: 144437766
- 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.
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 of 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
