Appeals Analyst

3 weeks ago

Rancho Mirage, United States Mobile Health Team LLC Full time

**Duties**:

- Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports.
- Responds to audit requests (including RAC) from payors.
- Maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation requirements.
- Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for future denials.

**Roles and Resposnibilities**:

- Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations
- Analyze denied, underpaid and unpaid claims. Appeal underpaid and denied claims within timely filing periods
- Identify, track and report on denial trends
- Maintain an appeals data base to identify and report outcomes and opportunities
- Identify any billing and/or coding trends resulting in denials and report to the Coding manager
- Identify any other trends resulting in denials and report to Manager.
- Attend all available coding and appeals related seminars as available
- Minimal/ No Potential

**Education**:

- Required: High School diploma or equivalent

**License and Certification**:

- Preferred: Certified coder or currently enrolled in a coding program

**Experience required**:

- Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing experience a plus.
- Preferred: three to five years of Patient Accounting in a high volume environment.

**Skills required**:

- Strong Analytical skills, Proficient in Microsoft Windows with emphasis on Excel.
- Ability to prioritize and coordinate workflow and attention to detail.
- Knowledge of CPT, HCPC and ICD 10 coding requirements with emphasis on modifiers and diagnosis association.
- Working knowledge of LCD’s, NCCI and MUE edits as well as a general knowledge of Commercial, HMO, and Medicare Advantage claims, authorization and documentation requirements.

**Shift timings**:09 AM - 05 PM

**Job Type**: Contract

Pay: $22.64 - $23.35 per hour

Expected hours: 40 per week

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift
- Day shift
- Monday to Friday

Work setting:

- Office

Ability to Relocate:

- Rancho Mirage, CA: Relocate before starting work (required)

Work Location: On the road

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