Durham, North Carolina
Tustin, California
Miami, Florida
Spokane, Washington
Durham, North Carolina
Posted: 01-Aug-24
Location: Los Angeles, California
Salary: Open
Categories:
Internal Number: 140833114
Take on a key role withina world-class, award-winning health system. Ensure the efficient delivery ofaward-winning patient care. Take your career in an exciting new direction. Youcan do all this and more at UCLA Health.
You will be responsiblefor adjusting medical and behavioral health claims resulting inover/underpayments due to errors in processing, system issues,provider-corrected claim submissions, Medicare Advantage Plan reconsiderations,regulatory changes, CMS provider fee schedule/prospective payment system,coding updates, provider contract/amendment updates, and any other relatedissues. Utilizing your critical thinking skills, you will perform root causeanalyses and adjust claims. You will:
- Work on standard and escalated adjustment cases initiated through regulatory complaints or via other key stakeholders
- Analyze and research complex post-paid healthcare claims to determine accuracy or mitigate payment errors
- Review claims for appropriate application of benefits, contract interpretation, and application/compliance with policies and procedures
- Determine accuracy/appropriateness of internal or external request for payment/denial reconsideration
Salary Range: $30.56/hour - $60.82/hour
We're seeking aself-motivated, detail-oriented, deadline-driven individual with:
- Five or more years of medical claims payment experience ina MAPD HMO environment (i.e. MSO, IPA, or health plan).
- Expertise in industry-standard claims adjudicationpolicies, procedures and processes including CCI edits, benefit and COBdetermination, DOFR interpretation and the application of Medicare Guidelines
- Knowledge of fee schedule and pricing methodologies foroutpatient/inpatient institutional, ancillary, and professional claims
- Understanding of CPT, HCPCS, ICD-10, ASA, Revenue Codes
- ·Experience researching and resolving provider disputeresolutions, adjustments, appeals, and reopen guidelines
- Ability to use Claim Adjustment Reasons and RemittanceAdvice Remark codes
- Knowledge of medical terminology
- Ability to accurately key between 6,000 and 8,000keystrokes or type 40-50 WPM
- Strong analytical, mathematical, organizational, andproblem-solving skills
- Computer proficiency with Microsoft Word and Excel
- Knowledge of claims adjudication systems (e.g.,EPIC-Tapestry, QNXT, IDX Facets).
- Willingness to learn new technologies, practices, andprocedures
