BatonRougeRecruiter Since 2001
the smart solution for Baton Rouge jobs

Grievance & Appeals Auditor I (Remote)

Company: Anthem, Inc
Location: Baton Rouge
Posted on: January 15, 2020

Job Description:

Grievance & Appeals Auditor I (Remote) (PS29104)Location: United StatesNewRequisition #: PS29104Post Date: 5 days agoYour Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.Grievance/Appeals Auditor IThe Grievance/Appeals Auditor (Medicare Appeals and Grievance (MCAG)) is responsible for post completion examination of grievances and appeals in multiple states.Primary duties may include, but are not limited to:

  • 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.
  • Associates at this level handle routine audits and may receive guidance from G&A Auditor II's.Qualifications
    • Requires a BA/BS degree;
    • A minimum of 1 year of grievance and appeals experience;
    • Or any combination of education and experience which would provide an equivalent background.Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, Baton Rouge , Grievance & Appeals Auditor I (Remote), Accounting, Auditing , Baton Rouge, Louisiana

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Accounting, Auditing Jobs


Tax Professional
Description: What you'll do... Tax Professional Seeking experienced seasonal Tax Preparers eager to serve clients with diverse tax needs, generate business growth, and advance their tax knowledge. We offer competitive (more...)
Company: H&R BLOCK
Location: Baton Rouge
Posted on: 01/19/2020

First Year Tax Professional
Description: What you'll do...Do you have a passion for helping people and solving problems Are you constantly seeking knowledge and interested in a career where you'll work hard during tax season, and have the remainder (more...)
Company: H&R BLOCK
Location: Lafayette
Posted on: 01/19/2020

SAP FICO Asset Accounting Consultant
Description: IntroductionThe world is at a major turning point: technology is enabling entirely new forms of business operations, business models, industries and outcomes. We have exponentially more power to reach (more...)
Company: IBM
Location: Baton Rouge
Posted on: 01/19/2020


Internal Auditor
Description: EBREast Baton Rouge Parish School System -The East Baton Rouge Parish School System is accepting applications for Interim Internal Auditor. -Qualifications: Bachelor's degree in accounting from an accredited (more...)
Company: EBR SCHOOL SYSTEM
Location: Baton Rouge
Posted on: 01/19/2020

Denial Auditor - FMOL Health System
Description: Job DescriptionResponsible for handling administrative and medical appeals, directing and coordinating all aspects of denied claims provides coordination of comprehensive clinical documentation to third-party (more...)
Company: Franciscan Missionaries of Our Lady Health System
Location: Baton Rouge
Posted on: 01/19/2020

Accounting Assistant
Description: Personal Expectations ul li Friendly li Smart li Honest li Punctual li Self-Starter li Self-Motivated li Organized li Able
Company: Lightning Bolt
Location: Baton Rouge
Posted on: 01/19/2020

Night Auditor
Description: About UsWhere Canal Street meets Bourbon Street, the newly renovated Astor Crowne Plaza New Orleans provides luxury accommodations amid the beating heart of the legendary French Quarter. Discover a rich (more...)
Company: UNAVAILABLE
Location: New Orleans
Posted on: 01/19/2020

First Year Tax Professional
Description: What you'll do...Do you have a passion for helping people and solving problems Are you constantly seeking knowledge and interested in a career where you'll work hard during tax season, and have the remainder (more...)
Company: H&R BLOCK
Location: Baton Rouge
Posted on: 01/19/2020

Sr. Accountant
Description: DescriptionIf you have an aptitude for adaptability, you might be the Senior Accountant we're looking for. If you're an interested and qualified candidate for this Senior Accountant position, submit your (more...)
Company: Robert Half Management Resources
Location: New Orleans
Posted on: 01/19/2020

Business (Finance, Accounting, Economics) Tutor (more than $1k+/mo)
Description: Varsity Tutors is looking to contract with tutors to connect with clients across a variety of academic subjects and major test prep through
Company: Varsity Tutors
Location: Kenner
Posted on: 01/19/2020

Log In or Create An Account

Get the latest Louisiana jobs by following @recnetLA on Twitter!

Baton Rouge RSS job feeds