Appeals Resolution Analyst

Job Summary

Responsible for managing the end-to-end process of clinical appeals resolutions for Government Programs, the full-time Appeals Resolution Analyst will ensure compliance with timeliness and accuracy standards while working remotely.

Key responsibilities

• Handle the complete appeals process, including data entry, external reviews, and case completion
• Communicate with providers and members regarding appeal statuses and processes
• Collaborate with internal and external vendors to ensure compliance with regulatory standards

Required qualifications

• High School diploma or GED required; Bachelor's degree preferred
• Minimum of one year of recent acute care medical-surgical or rehabilitation experience preferred
• One year of utilization management experience preferred
• Knowledge of healthcare delivery systems, CPT-4, and ICD-9 coding required
• Experience with current medical management systems preferred