About this role
The Appeals Analyst will contribute in ensuring accurate and timely reimbursement by reviewing underpaid claims, identifying appeal opportunities, and partnering with payers and networks to resolve discrepancies. You will use a variety of tools, including contract management systems, to evaluate explanations of benefits (EOBs), analyze contract terms, prepare appeals, and monitor outcomes. The Appeals Analyst collaborates with our teams to share trends, support process improvements, and uphold the highest standards of confidentiality and compliance within a managed care environment. You will report to the Appeals Director.
Bachelor's degree in a related field or equivalent combination of education and relevant experience.At least two years of experience working with managed care claims and appeals in a healthcare professional services setting.Proficiency with Microsoft Office applications and familiarity with digital and remote office tools.Knowledge of medical terminology, managed care contracts, and the healthcare reimbursement environment.Experience with practice management systems (PMS), EOB imaging systems, and contract management software.Ability to work effectively in a production-focused environment while managing priorities with attention to detail.Responsibilities
Analyze underpaid or denied claims using Contract Manager tools and other available resources to identify appeal opportunities.Review EOBs, contract terms, and member information to verify payment accuracy and determine the appropriate appeal path.Prepare and submit written or phone-based appeals, ensuring clear communication.Track appeal activity, outcomes, and payment adjustments within the Contract Manager application.Partner with payers, networks, and company partners to resolve issues, monitor trends, and support continuous improvement efforts.Maintain strict confidentiality of medical records and patient data while participating in ongoing professional development related to managed care reimbursement. Benefits/Perks:
Our benefits include: Medical, life and dental insurance, Asociacion Solidarista, International Share Save Plan, Flex Work/Work from home, Paid time off, Annual Performance Bonus, Education Reimbursement, Family Bonding, Bereavement Leave, Referral Program, and more.
This is a fully remote job opportunity. #LI-Remote
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