Appeals Analyst

Summary

Join Experian Health as an Appeals Analyst and contribute to the future of U.S. healthcare. Reporting to the Client Organization, you will monitor contractual allowances, analyze appeal opportunities with payers and networks, and report performance. This role involves implementing processes for identifying under-allowed claims, reviewing EOBs, verifying contracts, batching appeals, submitting and monitoring appeals, and tracking outcomes. You will also build relationships with payer/network offices, track errors, provide feedback, participate in meetings, and maintain confidentiality. The position requires experience with managed care claims and appeals, healthcare contract manager applications, and healthcare professional services billing.

Requirements

• 2+ years' experience working with managed care claims and appeals for health care professional services (physicians and other health care professionals)
• 1+ years' experience with a healthcare contract manager application
• 2+ years experience with healthcare professional services billing (physicians and related health care professionals) and reimbursement environment
• Knowledge of major types of practice management system (PMS) and EOB imaging systems, with experience working with at least one industry leading PMS and of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.as well as managed care contracts and compliance

Responsibilities

• Implement processes for identifying under-allowed claims using Experian Health Contract Manager Product and other available tools
• Review and analyze EOBs for identified under-allowed claims
• Verify applicable contract as dictated by operational procedures: reviewing EOB messages
• Review patient ID card, verifying member information for managed care plans
• Batch appeals by payer or network, by CPT/HCPCS code combination, by error type, or by provider
• Compile and submit appeals, and monitor for proper reimbursement
• Utilize Contract Manager application to track appeals and appeal outcomes
• Establish and cultivate contacts in payer or network offices
• Track contractual, billing, registration, and posting errors, and provide feedback to Appeals Manager
• Participate in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts
• Maintain the strict confidentiality required for medical records and other data
• Participate in professional development efforts to ensure currency in managed care reimbursement trends

Benefits

• Great compensation package and bonus plan
• Core benefits including medical, dental, vision, and matching 401K
• Flexible work environment, ability to work remote
• Flexible time off including volunteer time off, vacation, sick and 12-paid holidays