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Nicklaus Children’s Health System
Miami, Florida
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Details
Posted: 14-Dec-24
Location: Los Angeles, California
Categories:
Admin / Clerical
Internal Number: 145209342
DescriptionAs 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
About UCLA
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