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Job Saved Save Job

Appeals and Grievances Analyst

UCLA

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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