Appeals Analyst positions

hace 3 semanas

San Francisco, Heredia, Costa Rica Experian A tiempo completo
Job Description

The Healthcare Appeals Analyst is 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 software 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 software to track appeals and recoveries.
  • Establishes and cultivates helpful and effective contacts in payer or network offices.
  • Establishes follow-up protocol with payers and networks.
  • Prepares monthly performance statistics regarding appeals and recoveries.
  • 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
Qualifications

Education and Experience:

  • High School completed and with some university studies preferred.
  • Minimum of 1-2 years' experience working with managed care claims and appeals for health care professional services (physicians and other health care professionals).
  • Experience in a production environment desirable but comfort in such an environment is essential.
  • Equivalent combination of education and experience may be considered

Knowledge:

  • Advanced knowledge and PC skills, with proficiency in utilizing Microsoft office products (Word, Excel, Outlook, etc.). Intermediate to advance level in Excel.
  • Knowledge of the health care professional services billing (physicians and related health care professionals) and reimbursement environment.
  • Knowledge of medical terminology.
  • Knowledge of networks, IPAs, MSOs, HMOs, PPOs and contract affiliations preferred.
  • Knowledge of managed care contracts and compliance preferred.

Skills:

  • Demonstrated skill in gathering and reporting claims information.
  • Demonstrated skill in written and oral communication with colleagues, supervisors, and payer/network personnel.
  • Demonstrated skill working in a team-oriented structure to achieve goals.
  • Demonstrated skill in problem solving and research.

Abilities:

  • Ability to work effectively with other departments and management.
  • Ability to identify, analyze and solve problems and to recognize patterns in data.
  • Ability to learn, understand and use multiple computer applications.
Additional Information

**This is a permanent home-based role in Costa Rica. No Visa sponsorship or relocation available.**

Our goal is to create a thriving, inclusive and diverse team where people love their work and love working together. We believe that diversity, equity and inclusion is essential to our purpose of creating a better tomorrow. We value the uniqueness of every individual and want you to bring your whole, authentic self to work. For us, this is The Power of YOU and it ensures that we live what we believe.

All your information will be kept confidential according to EEO guidelines. Experian is proud to be an Equal Opportunity and Affirmative Action employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner.

The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.

EOE including Disability/Veterans

  • Appeals Analyst Positions

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Experian A tiempo completo

    Full-timeEmployee Status: RegularRole Type: HybridDepartment: HealthcareSchedule: Full TimeCompany Description: Our mission is to use data driven insights to simplify healthcare for all. Simply put, we want to make the healthcare system work better for us as consumers and for those who work in healthcare. Our ONE Experian Health culture is the centerpiece of...

  • Appeals Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Experian A tiempo completo

    Company DescriptionExperian is the world's leading global information services company, unlocking the power of data to create more opportunities for consumers, businesses, and society. We are thrilled to share that FORTUNE has named Experian one of the 100 Best Companies to work for. In addition, for the last five years, we've been named in the 100 "World's...

  • Appeals Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Experian A tiempo completo

    Company Description Our mission is to use data driven insights to simplify healthcare for all. Simply put, we want to make the healthcare system work better for us as consumers and for those who work in healthcare. Our ONE Experian Health culture is the centerpiece of making this happen. Our aspiration is to bring people together who are driven by purpose...

  • Appeals Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Experian A tiempo completo

    Company DescriptionExperian is the world's leading global information services company, unlocking the power of data to create more opportunities for consumers, businesses, and society. We are thrilled to share that FORTUNE has named Experian one of the 100 Best Companies to work for. In addition, for the last five years, we've been named in the 100 "World's...

  • Appeals Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Experian A tiempo completo

    Full-timeEmployee Status: RegularRole Type: HybridDepartment: HealthcareSchedule: Full TimeShift: Day ShiftCompany Description: Our mission is to use data driven insights to simplify healthcare for all. Simply put, we want to make the healthcare system work better for us as consumers and for those who work in healthcare. Our ONE Experian Health culture is...

  • Appeals Collector

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary:You will be working for a fast-growing business process outsourcing provider to provide support to one of our largest accounts and leading provider of healthcare services. This provider serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually.As an appeals collector for one of the leading healthcare...

  • Appeals Specialist

    hace 3 semanas

    San Francisco, Heredia, Costa Rica GRUPO STT A tiempo completo

    ResponsibilitiesTriage incoming inventory for the Appeals team, validating appeal criteria is metCompose technical denial arguments for reconsideration, including both written and telephonicallyIdentify contract protection that can be leveraged to overturn denials.Overcome objections that prevent payment of the claim and gain commitment for payment through...

  • Jr Appeals Discrepancy Collector

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary:You will be working for a fast-growing business process outsourcing provider to provide support to one of our largest accounts and leading provider of healthcare services. This provider serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually.As an appeals underpayment collector for one of the leading...

  • Appeals Discrepancy Collector

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary:You will be working for a fast-growing business process outsourcing provider to provide support to one of our largest accounts and leading provider of healthcare services. This provider serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually.As an appeals underpayment collector for one of the leading...

  • Appeals Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Experian A tiempo completo

    Company Description Our mission is to use data driven insights to simplify healthcare for all. Simply put, we want to make the healthcare system work better for us as consumers and for those who work in healthcare. Our ONE Experian Health culture is the centerpiece of making this happen. Our aspiration is to bring people together who are driven by purpose...

  • Appeals Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Experian A tiempo completo

    Full-timeEmployee Status: RegularRole Type: HybridDepartment: HealthcareSchedule: Full TimeShift: Day ShiftCompany Description: Our mission is to use data driven insights to simplify healthcare for all. Simply put, we want to make the healthcare system work better for us as consumers and for those who work in healthcare. Our ONE Experian Health culture is...

  • Pre-bill Denial Unworked Pdu

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary:The Health Care Specialist will review post-discharge, prebill accounts that do not have authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that does not require a clinical review. Communicates with third-party payors to resolve...

  • Jr Appeal Specialist

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary:You will be working for a fast-growing business process outsourcing provider to provide support to one of our largest accounts and leading provider of healthcare services. This provider serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually.As an appeals collector for one of the leading healthcare...

  • Healthcare Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary:The Healthcare Analyst is responsible for supporting all activities related to government logging and discrepancy analysis function which includes verifying the accuracy of calculated discounts and analyzing discrepancies to determine root cause and resolution steps.Responsibilities: Ensure government discrepancy analysis and processes are...

  • Pre-bill Denial Unworked Pdu

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary:The Jr Health Care Specialist will review post-discharge, prebill accounts that do not have authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that does not require a clinical review. Communicates with third-party payors to resolve...

  • Ap Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Equifax A tiempo completo

    Equifax is where you can power your possible. If you want to achieve your true potential, chart new paths, develop new skills, collaborate with bright minds, and make a meaningful impact, we want to hear from you.The Intermediate Accounts Payable Analyst will be an organized, detail-oriented person, responsible for processing invoices through excel reports...

  • Healthcare Specialist

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary: You will be working for a fast-growing business process outsourcing provider to provide support to one of our largest accounts and leading provider of healthcare services. This provider serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually.In your role you will review post discharge, prebill accounts...

  • Appeals Discrepancy Collector Clerk

    hace 3 semanas

    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary:You will be working for a fast-growing business process outsourcing provider to provide support to one of our largest accounts and leading provider of healthcare services. This provider serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually.The Appeal Discrepancy Collector is responsible for researching...

  • Payroll Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica 11274 Citi Business Services Costa Rica, SRL A tiempo completo

    The Payroll Analyst 1 position is an entry-level professional role. It requires a solid understanding of various processes, procedures, and systems necessary to complete assigned tasks, along with a foundational comprehension of the underlying concepts and principles relevant to the role. A key aspect is grasping how the team collaborates with others to...

  • Senior Financial Analyst

    hace 3 semanas

    San Francisco, Heredia, Costa Rica FusionHit A tiempo completo

    We are looking for an eager and experienced Senior Financial Analyst to join our management team here at FusionHit. Applicants must live in and be authorized to work in Costa Rica and speak English at a minimum of B2 level. Additional details are below - we hope to talk to you soonJob Overview:As a Senior Financial Analyst, you will be responsible for...