Full-Time Appeals Analyst

• Implements process for identifying under-allowed claims.
• Reviews and analyzes EOBs for identified under-allowed claims.
• Verifies applicable contract by reviewing EOB messages, patient ID card, verifying member information for managed care plans.
• Prepares 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 strict confidentiality.
• Participates in professional development efforts.

• Advanced PC skills, with proficiency in utilizing Microsoft office products.
• Knowledge of the health care professional services billing and reimbursement environment.
• Knowledge of major types of practice management system (PMS) and EOB imaging systems.
• Knowledge of medical terminology.
• Knowledge of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.
• Knowledge of managed care contracts and compliance.

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