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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
01/19/2024
Salary Range: $76200 - 158800 Annually
Employment Type
2 - Staff: Career
Duration
Indefinite
Job #
11945

Primary Duties and Responsibilities

Take on a significant role within a world-class health organization. Elevate the operational effectiveness of a complex health system. Take your professional expertise to the next level. You can do all this and more at UCLA Health.

As a key member of our Medicare Advantage Operations team, you will develop detailed requirements specifications to meet our business needs. This will involve working directly with and serving as a liaison between business units, external trading partners, IT, and support teams. You will:

  •         Ensure functional and non-functional requirements are understood and implemented
  •         Perform testing, design, and delivery requirements
  •         Identify, analyze, quantify, and mitigate business risks
  •         Deliver and update training documentation
  •         Generate ad hoc reports to support the operations team

Salary Range: $76,200 - $158,800/annually

Job Qualifications

We’re seeking a self-motivated, adaptable, customer-focused, results-driven individual with:

  • Required Bachelor’s degree in business, information systems, healthcare, or a related field
  • Five or more years of experience managing enrollment, claims, or encounters in a Medicare or managed care environment required
  • Five or more years of experience with CMS processes required
  • Computer proficiency with Microsoft Office, SQL, and data visualization tools
  • Knowledge of encounter regulatory reporting and compliance requirements
  • Experience managing vendors to contractual requirements
  • Ability to research and resolve encounter issues
  • Understanding of the healthcare model, capitation, and other managed care IPA and provider reimbursement methodologies
  • Knowledge of physician/facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue and HCPCS coding
  • Strong leadership, interpersonal, analytical, problem-solving, and prioritizing skills
  • Excellent oral and written communication skills
  • Ability to develop, implement, and evaluate methods and systems to improve efficiency
  • Ability to work well independently as well as part of a team

UCLA Health is a world-renowned health system with four award-winning hospitals and more than 260 community clinics throughout Southern California. We are also home to the David Geffen School of Medicine, a highly respected leader in the development of breakthrough medical research and outstanding clinical professionals. If you’re looking to experience greater challenge and fulfillment in your career, you can at UCLA Health. 


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.