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General Information

Work Location: Los Angeles, USA
Onsite or Remote
Flexible Hybrid
Work Schedule
Monday - Friday; 7:00 AM - 4:00 PM PST
Posted Date
11/05/2024
Salary Range: $28.3 - 54.74 Hourly
Employment Type
2 - Staff: Career
Duration
Indefinite
Job #
20310

Primary Duties and Responsibilities

Contribute to the success of a world-class healthcare organization by ensuring compliance in regulatory audits and appeals. Leverage your expertise to support UCLA Health’s commitment to accuracy and quality in claim processing.

As an Audit and Appeals Specialist, you will:

  • Facilitate responses to regulatory audits related to billing, coding, and collection practices in compliance with federal and state guidelines
  • Collect, analyze, and enter audit requests into relevant systems, distributing requests to necessary teams
  • Monitor audit response and appeal statuses, tracking cases and maintaining updated records in various systems
  • Review claim denials for clinical issues, prepare appeals, and manage each case's resolution process
  • Develop internal compliance controls, addressing billing standards, regulatory updates, and potential operational gaps
  • Support reporting on audit trends, outcomes, and compliance initiatives

Join UCLA Health to uphold high standards in healthcare auditing and compliance, contributing to operational excellence.

Salary Range: $28.30 - $54.74 per hour.

Job Qualifications

We’re seeking a knowledgeable, detail-oriented professional with:

  • Bachelor’s degree in a clinical or related field, or equivalent training and experience
  • Certification in clinical coding or compliance, strongly preferred
  • Basic understanding of audit and appeals processes, including methods, tools, and regulatory standards affecting claims submission and payment
  • Project management skills, including effective time management, prioritization of competing priorities, and the ability to address complex issues and risks to ensure projects meet schedules and budgets
  • Strong collaboration skills to work effectively with internal and external stakeholders
  • Excellent communication skills, with the ability to convey complex clinical and technical information clearly and concisely, both in writing and verbally
  • Ability to contribute to high-quality reporting and documentation, including the development of training materials for diverse stakeholder groups

As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.