Solutions Design Analyst
Clario
Appeals Analyst
Experian
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇨🇷 Costa Rica
Visit company websiteJob Level
JuniorMid-Level
About the role
- Responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.
- Implements process for identifying under-allowed claims using Contract Manager Product and other available tools.
- Reviews and analyzes EOBs for identified under-allowed claims.
- Verifies applicable contract by, as dictated by operational procedures: reviewing EOB messages, reviewing patient ID card, verifying member information for managed care plans.
- Batches appeals by payer or network, by CPT/HCPCS code combination, by error type, or by provider.
- Compiles and submits appeals, and monitors for proper reimbursement.
- Uses Contract Manager application to track appeals and appeal outcomes.
- Establishes and cultivates helpful and effective contacts in payer or network offices.
- Monitors and tracks contractual, billing, registration, and posting errors, and provides continuous feedback to Appeals Manager.
- Participates in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts.
- Maintains the strict confidentiality required for medical records and other data.
- Participates in professional development efforts to ensure currency in managed care reimbursement trends.
Requirements
- Bachelors degree in related field, or equivalent education and experience.
- Minimum of two years experience working with managed care claims and appeals for health care professional services (physicians and other health care professionals).
- Experience working with a Contract Manager application
- Experience in a production environment is desirable but comfort in such an environment is essential.
- Experience with digital & remote office equipment
- Knowledge of the health care professional services billing (physicians and related health care professionals) and reimbursement environment.
- Knowledge of major types of practice management system (PMS) and EOB imaging systems, with experience working with at least one industry leading PMS
- Knowledge of medical terminology.
- Knowledge of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.
- Knowledge of managed care contracts and compliance.
Benefits
- Medical, life and dental insurance
- Asociación Solidarista
- International Share Save Plan
- Flex Work/Work from home
- Paid time off
- Annual Performance Bonus
- Education Reimbursement
- Family Bonding
- Bereavement Leave
- Referral Program
- more.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
managed care claimsappeals processingContract Manager applicationbillingEOB analysisCPT codeHCPCS codemedical terminologypractice management systemEOB imaging systems
Soft skills
analytical skillscommunicationorganizational skillsattention to detailconfidentialitycollaborationproblem-solvingfeedback provisionprofessional developmentrelationship building
Certifications
Bachelor's degree