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General Information

Work Location: Los Angeles, USA
Onsite or Remote
Flexible Hybrid
Work Schedule
Monday-Friday, 8:00am-5:00pm PST
Posted Date
11/13/2024
Salary Range: $31.45 - 43.17 Hourly
Employment Type
2 - Staff: Career
Duration
Indefinite
Job #
20165

Primary Duties and Responsibilities

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

Job 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