Provider Non-Contracted Appeals and Claims Analyst

Location: Los Angeles, CA

Duration: 3 months, contract to hire

Responsibilities:

• 3+ years’ experience processing Medicare Advantage provider appeals from all types of providers (hospitals, physicians, ancillary)
• 3+ years’ experience in examining all types of medical claims, preferably Medicare Advantage claims
• Working knowledge of claims processing systems (EZCAP preferred)
• Working knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-9, ICD-10, DRG, etc.
• Understanding of different payment methodology such as Medicare PPS (MS-DRG, APC, etc.), Medicare Physicians fee schedule, Per Diem, etc.,
• Understanding of Division of Financial Responsibility on how they apply to claims processing
• Familiarity with billing and coding edits, coordination of benefits, MA Organization, Determination, Appeals and Grievance procedures
• Proven problem-solving skills and ability to translate knowledge to the department
• Working knowledge of Microsoft Office Programs (Outlook, Excel and Word)
• Excellent verbal and written communication skills
• Strong Organizational Skill and ability to multitask
• Attention to Detail
• High School Diploma required
• Bachelor’s Degree in related field, a plus
• #LI-JK1