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Grievance & Appeals Auditor

Kelly Services

Cerritos, CA
Job Code:
Kelly Services
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Job Details

Job Title Grievance & Appeals Auditor

Jobid US41LCGR_BH1446554

Location: Cerritos, CA, 90703, USA

Description Hello,

My name is George Rogers and I am a Recruiter with Kelly Services, Inc., a Fortune 500 workforce solutions company. We are currently seeking to fill an **Grievance & Appeals Auditor** position in **Cerritos, CA** . I have attached the details of the opportunity below:

**Duration: 6+ months**

**Pay Rate: $36.57/hour**

Your responsibilities will include (but not limited to):

Responsible for post completion examination of grievances and appeals in multiple states.

+ 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 to complex audits and function as subject matter experts.

+ Requires a BA/BS degree, a minimum of 2 years of grievance and appeals experience
+ Healthcare industry required
If you are interested in hearing additional information about this opportunity, please contact me via phone at **(352) 585-2109** or email an updated copy of your resume to .

**George Rogers I Recruiter - Finance / Accounting & Professional Services**

**Kelly Services, Inc. I GTS – Recruiting and Sourcing**


W: 352-585-2109 at

**Why Kelly** **®** **?**

At KellyServices ® , we work with the best. Our clients include 95 of the Fortune100 ™ companies, and more than 70,000 hiring managers rely on Kelly annually to accessthe best talent to drive their business forward. If you only make one career connection today, connectwith Kelly.

**AboutKelly Services** **®**

As a workforce advocate for over 70 years, we are proud to directly employ nearly 500,000 peoplearound the world and have a role in connecting thousands more with work through our global network oftalent suppliers and partners. Revenue in 2017 was $5.4 billion. Visit and connect with us on Facebook, LinkedIn and Twitter .

Kelly Services is an equal opportunity employer including, but not limited to, Minorities, Females,Individuals with Disabilities, Protected Veterans, Sexual Orientation, Gender Identity and iscommitted to employing a diverse workforce. Equal Employment Opportunityis The Law.

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