Appeals and Grievances Analyst

University of California - Los Angeles Health
United States, California, Los Angeles
Nov 13, 2024
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