Healthcare Appeals Analyst
L5
virtual vocationsNew York, NY8 days ago
Occupations
Administrative Law Judges, Adjudicators, and Hearing OfficersHealth Information Technologists and Medical RegistrarsCompliance ManagersIndustries
All Other Miscellaneous Ambulatory Health Care ServicesDirect Health and Medical Insurance CarriersElectromedical and Electrotherapeutic Apparatus ManufacturingReviewing provider appeals in a full-time remote capacity, the Healthcare Appeals Analyst will apply established procedures and regulations to ensure accurate claim determinations, negotiate settlement offers, and maintain detailed records of appeal activities.
Key responsibilities:
Review appeals from providers while adhering to Standard Operating Procedures (SOPs) and maintaining timely communication
Calculate and propose settlement offers based on claim history and relevant data
Prepare and issue denial determinations based on appeal reviews, ensuring compliance with applicable policies Required qualifications 2+ years of experience in healthcare claims, provider appeals, or medical billing
Knowledge of CPT-4, HCPCS, Revenue Codes, DRG, and ICD-10 coding
Familiarity with ERISA guidelines and the No Surprise Act
Proficiency in Microsoft Outlook, Teams, and Excel
Experience in provider negotiations and evaluating counter offers for claim settlements
Apply now
Level
SeniorL5
Location
New York, NY
Occupation
Administrative Law Judges, Adjudicators, and Hearing Officers
Industry
All Other Miscellaneous Ambulatory Health Care Services
Posted
8 days ago
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