Appeals Analyst Full Time

Position Goal

Responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.

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, as dictated by operational procedures : reviewing EOB messages, reviewing patient ID card, verifying 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, when applicable, by payer or network, by CPT / HCPCS code combination, by error type, or by provider
• Compiles and submits appeals and monitors for proper reimbursement
• Uses Experian Contract Manager to track appeals and recoveries
• Establishes and cultivates helpful and effective contacts in payer or network offices
• Establishes follow-up protocol with payers and networks
• Monitors and tracks contractual, billing, registration, and posting errors, and provides continuous 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

Experience : Five years with insurance claims / related experience, CPT and ICD-10 terminology experience required or three years of above described experience with an Associates degree or higher in related field Education : High school diploma or equivalent required. Associates degree or higher preferred.

Special Qualifications (required) :

Special Qualifications (preferred) :