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Appeals and Grievances Analyst
UCLA
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Details

Posted: 14-Nov-24

Location: Los Angeles, California

Salary: Open

Categories:

Admin / Clerical

Internal Number: 144437756

Description

As 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 

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About UCLA
At UCLA Health, you can help heal humankind, one patient at a time by improving health, alleviating suffering and delivering acts of kindness. As you do, you’ll achieve great things in your life and your career. We’re a world-class health organization with four hospitals consistently recognized among the nation’s very best as well as an internationally-renowned medical school, primary and specialty care clinics and much more. Within our dynamic, innovative and growing organization, you’ll find exceptional opportunities to make the most of your abilities in a supportive, empowering and inclusive environment. If you embrace our values of Integrity, Compassion, Respect, Teamwork, Excellence and Discovery we invite you to see all you can accomplish at UCLA Health.
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