Healthcare Appeals Specialist

hace 2 meses


San Francisco, Heredia, Costa Rica Experian A tiempo completo

About the Role

We are seeking a skilled Healthcare Appeals Specialist to join our team at Experian. In this role, you will be responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.

Key Responsibilities

  • Implement processes for identifying under-allowed claims using software and other available tools
  • Review and analyze EOBs for identified under-allowed claims
  • Verify applicable contract by reviewing EOB messages, reviewing patient ID card, verifying member information for managed care plans
  • Use feedback and experience to refine communication skills and tools for use in preparing written and telephone appeals
  • Batch appeals by payer or network, by CPT/HCPCS code combination, by error type, or by provider
  • Compile and submit appeals, and monitor for proper reimbursement
  • Use software to track appeals and recoveries
  • Establish and cultivate helpful and effective contacts in payer or network offices
  • Establish follow-up protocol with payers and networks
  • Prepare monthly performance statistics regarding appeals and recoveries
  • Monitor and track contractual, billing, registration, and posting errors, and provide continuous feedback to Appeals Manager
  • Participate in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts
  • Maintain the strict confidentiality required for medical records and other data
  • Participate in professional development efforts to ensure currency in managed care reimbursement trends

Requirements

  • 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

About Us

Experian is proud to be an Equal Opportunity and Affirmative Action employer. We believe in creating a thriving, inclusive and diverse team where people love their work and love working together. Our goal is to create a better tomorrow, and we value the uniqueness of every individual and want you to bring your whole, authentic self to work.



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