Appeals analyst - healthcare

Descripción general

The Healthcare Appeals Analyst is responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.

Requisitos para aplicar

• High School Diploma
• Minimum of two years’ experience working with managed care claims and appeals for health care professional services (physicians and other health care professionals).
• Knowledge of the health care 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 highly desirable.
• Knowledge of medical terminology.
• Knowledge of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.
• Knowledge of managed care contracts and compliance.
Skills:
• Demonstrated skill in gathering and reporting claims information.
• 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.
• Demonstrated skill in problem solving and research.
Abilities:
• Ability to work effectively with other departments and management.
• Ability to identify, analyze and solve problems and to recognize patterns in data.
• Ability to learn, understand and use the software application.