Healthcare Appeals Analyst
Job Summary
Reviewing provider appeals and ensuring compliance with established procedures, the full-time remote Healthcare Appeals Analyst will calculate settlement offers, prepare documentation, and communicate outcomes while maintaining detailed records and adhering to regulatory guidelines.
Key responsibilities
- Review appeals from providers, ensuring adherence to Standard Operating Procedures (SOPs) and Service Level Agreements (SLAs)
- Calculate and propose settlement offers based on claim history and relevant data while maintaining compliance with ERISA and applicable regulations
- Maintain detailed documentation of appeal activities, negotiations, and outcomes, and communicate regularly with clients regarding appeal statuses
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 the No Surprise Act, ERISA guidelines, and related legislation
- Proficient in analyzing out-of-network claim appeals and utilizing claim pricing tools
- Experience with Microsoft Outlook, Teams, and Excel
Complete Job Description
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