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Appeals Analyst

Remote: 
Full Remote
Contract: 
Full time
Experience: 
Mid-level (2-5 years)
Work from: 
United States

Offer summary

Qualifications:

High School Diploma, College desired, 2-4 years experience in healthcare claims, Knowledge of ICD and CPT codes, Intermediate Microsoft Office skills.

Key responsabilities:

  • Monitor and track appeals status
  • Review and analyze appeals for validity
  • Document claim specifics in software
  • Consult with other entities on appeals
  • Respond to inquiries about the No Surprises Act
Allied Benefit Systems, LLC logo
Allied Benefit Systems, LLC Unicorn https://www.alliedbenefit.com/
501 - 1000 Employees
About Allied Benefit Systems, LLC
Allied is a national healthcare solutions company that works with organizations who choose to take control of their healthcare. We customize employer self-insurance benefits to align with individual choice and organizational need while integrating medical management innovations and cost-control strategies. With healthcare designed for people, employers never have to choose between price and the best-fit insurance products to protect employees and their families. Allied’s philosophy is to create a culture of health for our member organizations and their employees beyond simple, medical health. We integrate administrative services, care solutions and analytics to achieve better clinical, behavioral and social patient outcomes. Allied’s programs and benefit services are designed and structured to infuse value on every front – for employers and HR departments, for plan members and their families, for healthcare providers, and for us. We’re in this together, committed to your future.
See more Allied Benefit Systems, LLC offers

Job description

APPEALS ANALYST

POSITION SUMMARY:

The Appeals Analyst is responsible for monitoring and tracking the status of appeals as they relate to Allied’s Cost Containment program. The position involves reviewing appeals for appropriateness, documenting the claim specifics into the current software and routing documentation to business partners for review/resolution.

ESSENTIAL FUNCTIONS:

  • Independently review and analyze appeals related to Allied’s Cost Containment programs.
  • Review Summary Plan Documents to determine validity of appeals.
  • Review, analyze and add applicable notes to the QicLink System
  • Review/audit processed health care claims for accuracy.
  • Consult with other entities who can offer additional review of an appeal.
  • Respond timely and appropriately to inquiries related to the No Surprises Act, including Independent Dispute Resolution (IDR) and open negotiation requests.
  • Other duties as assigned.

EDUCATION

  • High School Diploma, College and Advanced Degrees Preferred

Experience & Skills

  • Knowledge of International Classification of Diseases (ICD) and/or Current Procedural Terminology (CPT) codes required.
  • Intermediate level work experience with Microsoft Office, Word, Excel, and Power Point applications.
  • Ability to multi-task, this includes ability to understand multiple products, multiple levels of benefits within each product and work within multiple systems.
  • Excellent verbal and written communication skills.
  • Strong analytical and critical thinking skills.
  • Excellent organizational skills and mindfulness.
  • Excellent time management skills with a proven ability to meet deadlines.
  • 2-4 years’ experience analyzing healthcare claims (processing claims)

COMPETENCIES

  • Job Knowledge
  • Time Management
  • Accountability
  • Communication
  • Initiative
  • Customer Focus

PHYSICAL DEMANDS

  • Ability to sit for extended periods of time. Ability to communicate via telephone.

WORK ENVIRONMENT

  • Remote

Required profile

Experience

Level of experience: Mid-level (2-5 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Hard Skills

AppealsCPT CodingClaims ProcessingICD Coding (ICD-9/ICD-10)

Other Skills

  • Multitasking
  • Organizational Skills
  • Microsoft Office
  • Critical Thinking
  • Analytical Thinking
  • Verbal Communication Skills
  • Time Management
Are you interested?

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