Healthcare Appeals Analyst
Job Summary
Reviewing provider appeals in a full-time remote capacity, the Healthcare Appeals Analyst will apply established procedures and regulations to ensure accurate claim determinations, negotiate settlement offers, and maintain detailed records of appeal activities.
Key responsibilities
- Review appeals from providers while adhering to Standard Operating Procedures (SOPs) and maintaining timely communication
- Calculate and propose settlement offers based on claim history and relevant data
- Prepare and issue denial determinations based on appeal reviews, ensuring compliance with applicable policies
Required qualifications
- 2+ years of experience in healthcare claims, provider appeals, or medical billing
- Knowledge of CPT-4, HCPCS, Revenue Codes, DRG, and ICD-10 coding
- Familiarity with ERISA guidelines and the No Surprise Act
- Proficiency in Microsoft Outlook, Teams, and Excel
- Experience in provider negotiations and evaluating counter offers for claim settlements
Complete Job Description
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