San Juan, Puerto Rico,
Atlanta, Georgia, Georgia
Miami, Florida
Charleston, South Carolina, South Carolina
Scottsbluff, Nebraska
Corpus Christi, Texas
Los Angeles, California
Portland, Oregon
Anderson, South Carolina, South Carolina
Great Falls, Montana
Posted: 14-Nov-24
Location: Los Angeles, California
Salary: Open
Categories:
Internal Number: 144437746
- 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
