You can make a difference in people’s lives every day. When you join UCLA Health, you’ll be working at an institution that provides leading-edge care to the people of L.A. and throughout the world. We provide our team members with the environment and support to do amazing work, because each and every one of them plays a vital role in our commitment to care.
Take on a key role within a world-class, award-winning health system. Elevate the operational effectiveness of an award-winning healthcare leader. Take your career in an exciting new direction. You can do all this and more at UCLA Health.
You will be responsible for the accurate analysis and resolution of provider disputes. This will require extensive knowledge of CMS Medicare Advantage regulatory requirements, Department of Financial Responsibility (DOFR) provisions, and internal operation requirements, policies, and procedures. You will:
- Review and process provider dispute resolutions according to state and federal designated timeframes
- Research and respond to provider inquiries related to claims payments
- Research reported issues; adjust claims and determine the root cause of the dispute
- Draft written responses to providers in a professional manner within required timeliness
- Ensure the accurate and timely processing of PDR documents
- Serve as subject matter expertise in evaluating and responding to all provider disputes
- Analyze complex post-paid healthcare claims
- Apply in-depth research to determine accuracy and mitigate payment errors
- Communicate with external and internal providers, both verbally and in writing related to the cases under review
- Coordinate with other departments as necessary to facilitate resolution of claim related issues. Identify and report claim related claim issues for provider education
We’re seeking a self-motivated, detail-oriented, deadline-driven individual with:
- Five or more years of healthcare claim processing experience in a managed care environment
- One or more years of experience with provider disputes
- Experience processing PDR documents
- Ability to interpret provider contracts and apply them to claims adjudication
- Computer proficiency with Microsoft Office
- Strong math, communication, analytical, critical-thinking, and problem-solving skills
- Knowledge of medical terminology, claim forms, and physician billing coding
- Ability to read/interpret contracts, standard reference materials, etc.
UCLA Health is a world-renowned health system with four award-winning hospitals and more than 260 community clinics throughout Southern California. We’re also home to the world-class medical research and clinical education capabilities of the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles’ trusted provider of exceptional, compassionate patient care. If you’re looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.
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UCLA Health Recruitment is currently being targeted by scam artists through external job board sites. Review some tips in order to avoid becoming targeted. El reclutamiento de salud de UCLA actualmente está siendo atacado por estafadores a través de sitios de juntas de trabajo externos. Revisar algunos consejos para evitar ser apuntado.
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VINCENT, Sr. CLS Specialist, Toxicology
MONICA
I've been blessed to touch so many lives through my serving. It's a privilege to uplift other employees with words of encouragement and a smile.
SOZIT
The first thing i noticed when i joined the team was how everyone is very welcoming and friendly with supportive management. I did not feel like an outsider.
EDGAR
Once I joined, I knew UCLA Health was THE place to be due to the growth potential and training offered
RENE
If you want to grow professionally, this is the right place for you.
ERA
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ELIZABETH
It’s so diverse and inclusive here. There’s always the opportunity to share your thoughts. It's a place where you feel you belong.
JERRY
Your career path at UCLA Health will enable you to follow a myriad of avenues and turns. It opens up a wide variety of opportunities.
ORLANDO
There’s a togetherness and higher level of commitment to teamwork at UCLA Health. We are several groups and teams that work together with a common goal which is to improve our patients experience.
DAVID
UCLA Health walks the walk and talks the talk! It's an incredible feeling to work for an organization that always puts the patient first. I am honored to work in full alignment with the UCLA Health Mission and Vision.
DR. ISLA GARRAWAY
UCLA has incredible resources and a team science approach. The ability to work with collaborative teams and access the amazing resources around campus is the best part about being at UCLA.
RADU
UCLA is very diverse in its personnel as well as its many research fields studied
JENNA
UCLA Health provides so many opportunities to exchange ideas, share moments and grow. I have learned a lot about team management and relationship building.
SHARON
I was looking for a job to further my career and continue to improve and learn as a therapist.
TARO
I have been blessed to be surrounded by supportive colleagues who aspire me to be the best version of myself.