Managed Care Appeals Analyst

Job Summary

Researching and analyzing closed $0 balance accounts, the full-time Managed Care Appeals Analyst will ensure accurate reimbursement from payors, create appeals for underpayments, and monitor payment accuracy while working remotely.

Key responsibilities

• Perform daily reviews of $0 balance accounts to identify appropriate contractual reimbursement
• Create detailed appeals for underpaid services, utilizing supporting information from payor contracts
• Contact payor sources to confirm eligibility and resolve claims issues, documenting all findings in accordance with procedures

Required qualifications

• Associate or bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or a related field, or four additional years of relevant work experience in lieu of a degree
• 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