Appeals & Grievances Specialist

University of California - Los Angeles Health
United States, California, Los Angeles
Oct 31, 2024
Description As the Appeal & Grievance Specialist, you will be responsible for: Managing the intake and resolution of member and provider appeals and grievances in compliance with CMS (Centers for Medicare & Medicaid Services) regulations for Medicare Advantage plans Ensuring that all cases are processed within mandated timeframes and that clear, timely communication is provided to all stakeholders Working closely with medical director and appeal & grievance team to ensure that all cases are handled effectively Other duties as assigned Salary Range: $31.45-$43.17/hourly Qualifications We're seeking a detail-oriented individual with: Bachelor's degree in a healthcare related field or equivalent experience, preferred 2 or more years of experience in healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred Experience in interpreting CMS guidelines and working with regulatory requirements, preferred Strong knowledge of Medicare Advantage plans, CMS regulations, and the appeals and grievances process Excellent verbal and written communication skills Ability to handle sensitive and confidential information with discretion *Proficiency with case management software and Microsoft Office applications