Appeals Analyst - Full Time

Position Responsibilities

• Implements process for identifying under-allowed claims using Experian Contract Manager and other available tools
• Reviews and analyzes EOBs for identified under-allowed claims
• Verifies applicable contract by reviewing EOB messages, patient ID card, and member information for managed care plans
• Uses feedback and experience to refine communication skills and tools for use in preparing written and telephone appeals
• Batches appeals by payer or network, CPT/HCPCS code combination, error type, or provider
• Compiles and submits appeals and monitors for proper reimbursement
• Establishes and cultivates helpful and effective contacts in payer or network offices
• Establishes follow-up protocol with payers and networks
• Makes sure contractual, billing, registration, and posting errors are monitored and tracked, and provides feedback to the Director of Revenue Optimization Management
• Participates in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts
• Cross-trains and performs appeals analysis within Hospital claims, as needed
• Maintains the strict confidentiality required for medical records and other data
• Participates in professional development efforts to ensure currency in managed care reimbursement trends

Requirements

• Up-to-date coding certification; either CPC or coding credentials via AHIMA
• Knowledge and PC skills, with proficiency in utilizing Microsoft office products (Word, Excel, Outlook, PowerPoint, etc.)
• Knowledge of medical terminology
• Demonstrated skill in written and oral communication with colleagues, supervisors, and payer/network personnel
• Demonstrated skill working in a team-oriented structure to achieve goals
• Must be able to work independently

Qualifications

• Five years with insurance claims/related experience, or three years of above-described experience with a Associates degree or higher in related field