Healthcare Appeals Specialist

hace 2 semanas


San Francisco, Heredia, Costa Rica Experian A tiempo completo

Job Title: Healthcare Appeals Specialist

About the Role:

Experian is seeking a skilled Healthcare Appeals Specialist to join our team. 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 a process 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, and 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:

  • Bachelor's degree in a related field or equivalent experience.
  • Minimum of 1-2 years' experience working with managed care claims and appeals for healthcare professional services (physicians and other healthcare professionals).
  • Experience in a production environment desirable, but comfort in such an environment is essential.
  • Equivalent combination of education and experience may be considered.

Preferred Qualifications:

  • Advanced knowledge and PC skills, with proficiency in utilizing Microsoft office products (Word, Excel, Outlook, etc.).
  • Intermediate to advanced level in Excel.
  • Knowledge of the healthcare professional services billing (physicians and related healthcare 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.

Why Experian?

Experian is a company that values diversity, equity, and inclusion. We strive to create a thriving, inclusive, and diverse team where people love their work and love working together. We believe that diversity, equity, and inclusion are essential to our purpose of creating a better tomorrow.

Equal Opportunity Employer:

Experian is an Equal Opportunity Employer and welcomes applications from diverse candidates. We are committed to creating an inclusive and fair workplace environment for all employees. If you need accommodation to complete the interview process, please notify the talent acquisition partner.

Contact Information:

Please do not contact us with inquiries about this job posting. We will contact qualified candidates directly. Thank you for your interest in Experian.



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