State Licensed Appeals Analyst

Job Summary

Focused on ensuring compliance and customer satisfaction, the full-time State Licensed Appeals Analyst will research, analyze, and process appeals, coding disputes, and grievances while working remotely across multiple states.

Key responsibilities:

• Analyze and resolve confidential appeals, coding disputes, and grievances according to regulatory guidelines
• Prepare comprehensive responses and position statements for external reviews, ensuring compliance with accreditation standards
• Document investigations and findings in applicable systems while monitoring service timeliness and compliance

Required qualifications:

• Bachelor's degree or advanced degree where required
• 3 years of related experience, or 5 years in lieu of a degree
• Certification as a professional coder must be obtained within 1 year of employment for coding disputes
• Experience with healthcare claims adjudication appeals or reimbursement is highly preferred
• Knowledge of Medicare and/or Commercial CMS guidelines is highly preferred