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Location: Anaheim, CA
Duration: Permanent
Responsibilities:
- 3-5 years management experience in provider dispute and provider appeals resolutions, Medicare managed care or health plan setting;
- 5+ years experience in Medicare medical claims management in managed care setting
- Bachelor’s degree in healthcare management or related field; and/or equivalent experience
- Extensive knowledge of Medicare Managed Care organization determination, appeals and grievance requirements, specifically reconsideration and IRE submission requirements
- Comprehensive knowledge of Medicare ODAG and Part C reporting
- Strong knowledge of professional and institutional claims
- Knowledge of claims processing systems (EZCAP preferred) and claims audit tools
- Intermediate to Advance proficiency in MS Office products – Word, Access and Excel
- Comprehensive knowledge of Medicare Advantage claims processing requirements and other related regulatory requirements
- Working knowledge of different claims coding requirements and payment methodology (PPS, Medicare fee schedules, etc.)
- Ability to provide reporting requirements based on processes and/or regulatory requirements
- Knowledge of medical terminology
- Proven problem-solving skills and ability to translate knowledge to the department
- Strong organizational skills and decision-making and attention to details
- Ability to work well in a fast-paced and dynamic environment
- Excellent presentation and training skills; group motivation and supervisory skills
