Appeals Analyst

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Investigate claims that have been denied in collaboration with clients and their representatives.

• Document investigations and actions taken until resolution in a claims recovery system.

• Resolve claims by reviewing supporting documents, calculating due benefits, initiating payments, drafting appeal letters, guiding the resolution of complex claims, and auditing claims for correct payments.

• Navigate through various facility patient accounting systems.

• Prepare analytical reports based on gathered information.

• Analyze claims to assess the validity of denials and explore recovery options.

• Compose detailed and persuasive correspondence to facilitate reimbursement.

• Cultivate relationships with insurance carriers, patients, attorneys, and employers to enhance reimbursement processes.

• Conduct research to develop robust arguments for reimbursement.

• Review clinical policies, contracts, and other relevant materials to support claims recovery efforts.

• Collaborate both independently and as part of a team to identify trends and devise recovery strategies.

• Ensure compliance with legal guidelines, contracts, regulations, and the company’s business plan.

• Uphold quality service by adhering to provider and payer service practices and protocols.

⛳️ Requirements

• A high school diploma is required; an Associate's degree or higher is preferred.

• 2-4 years of experience in appeal and claims processing.

• Strong verbal and written communication skills.

• Excellent customer service abilities.

• Proficient analytical skills.

• Familiarity with MS Office Suite.

• Skills in negotiation, problem recognition, and resolution.

• Ability to handle multiple tasks simultaneously.

• Capable of navigating various facility patient accounting systems.

• A solid understanding of clinical policies, contracts, and regulations.

• Must pass a background check successfully.

• Must already possess authorization to work in the United States on a full-time, permanent basis without current or future sponsorship.

🏝️ Benefits

• Medical/Dental/Vision insurance.

• 401K company match.

• Flexible Paid Time Off.

• Paid parental leave.

• HSA/FSA options.

• Educational reimbursement program.

• Employer-paid EAP & Mental Health services.