Durham, North Carolina
Marshfield, Wisconsin
Posted: 17-Jul-24
Location: Los Angeles, California
Salary: Open
Categories:
Internal Number: 140299920
Take on a significant role within a world-class health organization. Elevate the operational effectiveness of a complex health system. Take your professional expertise to the next level. You can do all this and more at UCLA Health.
As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and running processes/jobs for electronic claims and other EDI transactions. This will involve working with external trading partners, transferring/loading data through secure channels, and testing files from new providers/trading partners. You will be responsible for claim encounter data submissions and the coordination of business transactions for all HIPPA/CMS standard sets. You will focus on delivering operational efficiencies and meeting claim data submission requirements.
Bachelor's degree in computer science, information technology, business, or a related field, and five years of experience, or an equivalent combination of education and experience required
Five or more years of experience with CMS processes in a Medicare or managed care environment
Must have 3-5 years of experience with Encounter submission (837 I, P, 999 and 277) to/from CMS is required
Advanced proficiency with SQL, SSIS package, data visualization tools, and Microsoft Office
Knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding
Extensive experience with claims encounter strategies and processes
Knowledge of claims payment methodologies, adjudication processing, and Federal encounter regulations
Knowledge of encounter regulatory reporting and compliance requirements
Previous vendor management experience
Ability to research and resolve encounter issues
Understanding of the health care model, capitation, and other managed care IPA and provider reimbursement methodologies
Excellent communication, interpersonal, analytical, and problem-resolutions skills
Ability to modify and adapt operational procedures to changing operational needs
Strong leadership, critical thinking, and prioritizing abilities
Ability to develop, implement, and evaluate methods and systems to improve efficiency
Ability to articulate ideas to both technical and non-technical staff
UCLA Health is a world-renowned health system with four award-winning hospitals and more than 260 community clinics throughout Southern California. We are also home to the David Geffen School of Medicine, a highly respected leader in the development of breakthrough medical research and outstanding clinical professionals. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.
