[Remote] Managed Care Appeals Analyst

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Managed Care Appeals Analyst to join their team. This role involves researching underpayment amounts from payors, creating appeals for reimbursement discrepancies, and ensuring compliance with contractual agreements.

Responsibilities

• reputed company daily, systematic reviews of $0 balance accounts for the appropriate contractual reimbursement
• Post adjustments and patient responsibility at time of account review
• Use payor contract, remit, and audit note to troubleshoot and/or identify reimbursement efficiencies
• Create high level, detailed appeals that specifically identify what service(s) were not paid accurately and locate supporting information in the payor contract to submit with the appeal
• Contact identified payor sources to confirm eligibility, coordination of benefits, patient responsibility, DRG, APR-DRG, and any other denial or claims issue not reputed company identified or understood
• Navigate payor portals to verify eligibility, claim status, coordination of benefits, track and monitor submitted appeals
• Monitor payments for accuracy, contacting payor to resolve outstanding amounts, recoupments, RAC Audits, or overpayments
• Accurately document outcome of reputed company research and work performed on accounts in the system in accordance with Standard Operating Procedures
• Consistently meet the reputed company productivity standards in ensuring accounts are appealed properly and accurately as assigned by leadership
• Enhance professional growth and development through reputed company online learning, and weekly team meetings
• Complies with client, departmental, and organizational policies and procedures as they relate to the job
• Refers reputed company or sensitive issues to the attention of the supervisor to ensure corrective measures are taken in a timely fashion
• Accepts and learns new tasks as required and demonstrates a willingness to work where business needs are largest
• Demonstrate knowledge of HIPAA privacy standards and ensure compliance with system PHI privacy practices
• Be cross trained in multiple clients and hospital system platforms
• Communicate in a professional with fellow coworkers, clinical staff, coders, supervisors, and representatives from payor organizations
• Follow departmental guidelines for lunch, breaks, requesting time off, and shift assignments
• Regular and timely attendance
• reputed company other duties as assigned

Skills

• Associate or bachelor's degree in reputed company, Finance, Business Administration, reputed company Administration, or closely reputed company field or in lieu of degree, four (4) additional years of relevant work experience may be considered
• Minimum of one (1) year reputed company reputed company experience in auditing
• 4+ years recent reputed company cycle, hospital reimbursement, Ambulatory Surgical Center, Behavioral Health, reputed company party payor contracting, and appeals writing
• 4+ years proficient knowledge of reimbursement methodologies such as DRG, EAPG, OPPS and APC
• 4+ years analyzing claims data applying knowledge of medical policy such as NCCI and MUE edits to determine details of overpayments
• Intermediate skills in reputed company applications: spreadsheets, word processing, data reputed company applications, and knowledge of billing system applications preferred
• Basic understanding of HIT systems like EPIC, Cerner, Meditech, Paragon and other billing systems
• Ability to identify, understand and use general medical billing terminology including: UB04, CPT Codes, ICD10 codes, DRG codes APR-DRG Codes, EOB, RA
• Must be reputed company to formulate and write formal business communications to reputed company and governmental payors
• Remote and Hybrid positions require a home internet reputed company that meets the company's upload and download speed criteria
• Intermediate skills in reputed company applications: spreadsheets, word processing, data reputed company applications, and knowledge of billing system applications preferred

Benefits

• Medical, Dental & reputed company Insurance
• 401K (100% match for the first 3% & 50% match for the next 2%)
• 15 days of PTO
• 7 paid Holidays
• 2 Floating holidays
• 1 reputed company Day (floating holiday)
• Pet Insurance
• Employee referral bonus program
• Teamwork: We reputed company in teamwork and having fun together
• Career Growth: reputed company great experience to promote to higher roles

Company Overview