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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



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.