Senior Appeals & Grievances Analyst

Description

As the Senior Appeals and Grievances Analyst, you will be responsible for:

• Assisting with all operational aspects of appeals and grievances, in accordance with state and federal regulations.

• Assisting the unit Supervisor in overseeing the appeals and grievances process, ensuring that members and providers receive fair and accurate resolutions to their concerns, and handled in accordance with all regulatory requirements.

• Collaborating with other organizational stakeholders, including other Appeals & Grievances team members, additional business units within UCLA Health, and external partners/vendors.

• Analyze, investigate, and process appeals and grievances in accordance with CMS/Medicare regulations and guidelines.

Salary Range: $38.12 - $52.33/hourly

Qualifications

We're seeking a detail-oriented, self-directed individual with:

• Healthcare experience preferred or another related field, required

• Three or more years of direct appeals and grievances experience in a Medicare or Managed Care setting, required

• Strong familiarity of benefits, enrollment/disenrollment, marketing, utilization management, required

• Knowledge of Medicare and CMS regulations, specifically pertaining to appeals and grievances, required

• Strong knowledge 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 (ie. Word and Excel), and Visio and data visualization tools, required

UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person's unique achievements and experiences to further set us apart.