Grievance Appeal Auditor

  • location: Cerritos, CA
  • type: Contract
  • salary: $34 - $37.10 per hour
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job description

Senior Project Manager - Cerritos, CA

  • This is a contract position expected to last 8 months.

Senior Project Manager - Job Duties:

  • Reviews case to determine applicability of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards.
  • Reviews case to assess whether it was appropriately handled as a clinical or administrative request and was correctly processed to avoid prompt pay penalties.
  • Evaluates urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review.
  • Reviews case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation.
  • Assists management in process improvement strategies to achieve business objectives.
  • Prepares audit findings and recommendations for G&A associates and management on a monthly basis. Identifies and communicates error trends to improve overall quality of enterprise G&A team.

Job Requirements:

  • Requires a BA/BS degree, a minimum of 2 years of grievance and appeals experience; or any combination of education and experience which would provide an equivalent background.

Compensation: $34.00-$37.10/hr

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