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 due from payors, create detailed appeals, and ensure accurate payments according to established contracts.

Key responsibilities

• Perform daily reviews of $0 balance accounts to ensure appropriate contractual reimbursement
• Create first and second level appeals for accounts not reimbursed accurately, using supporting information from payor contracts
• Monitor payments for accuracy and resolve outstanding amounts by contacting payors

Required qualifications

• Associate or bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or related field, or four 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, 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 and Cerner