Appeals Analyst

Position: Appeals Analyst

Job Type:                    Full-time

Status:                         Non-Exempt

Location:                    Hamilton NJ

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

Reports to: Director of Arbitration Litigation 

Position Purpose: Ensuring compliance with HIPAA regulations, including privacy and confidentiality, coordinate appeals to managed care/insurance company denials. Respond to post service appeals utilizing proprietary software within the company systems. Maintains multiple databases pertaining to denials and case management. Handling post service appeals for multiple states.

Primary Duties and Responsibilities:

• Conduct comprehensive reviews on provider bill denials to determine when an appeal is received.
• Review and respond to provider bill appeals on auto claims for multiple carriers.
• Identifies problematic issues or concerns and addresses them with the appropriate departments.
• Ensures the application of NJ state auto PIP regulations.
• Bill review processing for auto claims utilizing the MyMedlogix system.
• Other duties as assigned.

Job Requirements:

• Bachelor’s degree from an accredited college or university
• Knowledge of prior carrier or adjuster experience
• Knowledge of New Jersey No Fault PIP regulation, 1-2 years preferred
• Excellent problem solving, critical thinking and decision-making skills.
• Good communication skills, able to communicate clearly and succinctly, both verbally and in writing
• Good organizational skills

Physical requirements/Working conditions:

• Working remotely
• Ability to work in a climate-controlled office environment when required and/or necessary
• Minimal physical requirements
• Dynamic, time-sensitive environment

EEOC STATEMENT:

Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.