Full-Time Appeals Analyst
Experian is hiring a remote Full-Time Appeals Analyst. The career level for this job opening is Experienced and is accepting Heredia, Costa Rica based applicants remotely. Read complete job description before applying.
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Experian
Job Title
Appeals Analyst
Posted
Career Level
Full-Time
Career Level
Experienced
Locations Accepted
Heredia, Costa Rica
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Job Details
General Summary of Duties: Responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.
Essential Functions:
- 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.
- Uses feedback and experience to refine communication skills and tools for use in preparing written and telephone appeals.
- 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.
Knowledge:
- Advanced knowledge and PC skills, with proficiency in utilizing Microsoft office products (Word, Excel, Outlook, PowerPoint, etc.)
- 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 highly desirable.
- Knowledge of medical terminology.
- Knowledge of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.
- Knowledge of managed care contracts and compliance.
Skills
FAQs
What is the last date for applying to the job?
The deadline to apply for Full-Time Appeals Analyst at Experian is
25th of September 2025
. We consider jobs older than one month to have expired.
Which countries are accepted for this remote job?
This job accepts [
Heredia, Costa Rica
] applicants. .
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