Managed Care Appeals Analyst

Job Summary

Working remotely on a full-time basis, the Managed Care Appeals Analyst will research closed $0 balance accounts for underpayment amounts, create appeals for reimbursement discrepancies, and analyze payor trends per established contracts.

Key responsibilities

• Perform daily reviews of $0 balance accounts to ensure appropriate contractual reimbursement
• Create detailed appeals identifying unpaid services and supporting information from payor contracts
• Contact payor sources to confirm eligibility and resolve claims issues while documenting outcomes accurately

Required qualifications

• Associate or bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or related field, or four additional years of relevant work experience
• Minimum of one year of healthcare-related experience in auditing
• Four or more years of experience in revenue cycle management, hospital reimbursement, and appeals writing
• Proficient knowledge of reimbursement methodologies such as DRG, EAPG, OPPS, and APC
• Intermediate skills in Microsoft applications and basic understanding of HIT systems like EPIC or Cerner