Managed Care Appeals Specialist
hace 11 horas
The Managed Care Appeals Specialist will be responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.
About ExperianExperian 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 committed to creating a better tomorrow by helping people and economies flourish.
Responsibilities- Implement 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, patient ID card, and 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.
- High School completed and some university studies preferred.
- Minimum of one to two 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.
- 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.
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. Experian is proud to be an Equal Opportunity and Affirmative Action employer.
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