Audit and Appeal Specialist
2 weeks ago
Contribute to the success of a world-class healthcare organization by ensuring compliance in regulatory audits and appeals. Leverage your expertise to support UCLA Health's commitment to accuracy and quality in claim processing.
As an Audit and Appeals Specialist, you will:
- Facilitate responses to regulatory audits related to billing, coding, and collection practices in compliance with federal and state guidelines
- Collect, analyze, and enter audit requests into relevant systems, distributing requests to necessary teams
- Monitor audit response and appeal statuses, tracking cases and maintaining updated records in various systems
- Review claim denials for clinical issues, prepare appeals, and manage each case's resolution process
- Develop internal compliance controls, addressing billing standards, regulatory updates, and potential operational gaps
- Support reporting on audit trends, outcomes, and compliance initiatives
Join UCLA Health to uphold high standards in healthcare auditing and compliance, contributing to operational excellence.
Salary Range:$31.51 - $62.64 per hour.
QualificationsWe're seeking a knowledgeable, detail-oriented professional with:
- Bachelor's degree in a clinical or related field, or equivalent training and experience
- Certification in clinical coding or compliance, strongly preferred
- Basic understanding of audit and appeals processes, including methods, tools, and regulatory standards affecting claims submission and payment
- Project management skills, including effective time management, prioritization of competing priorities, and the ability to address complex issues and risks to ensure projects meet schedules and budgets
- Strong collaboration skills to work effectively with internal and external stakeholders
- Excellent communication skills, with the ability to convey complex clinical and technical information clearly and concisely, both in writing and verbally
- Ability to contribute to high-quality reporting and documentation, including the development of training materials for diverse stakeholder groups
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