Appeals Analyst

Company Description

Experian is a global data and technology company, powering opportunities for people and businesses around the world. We help to redefine lending practices, uncover and prevent fraud, simplify healthcare, create marketing solutions, and gain deeper insights into the automotive market, all using our unique combination of data, analytics and software. We also assist millions of people to realize their financial goals and help them save time and money.

We operate across a range of markets, from financial services to healthcare, automotive, agribusiness, insurance, and many more industry segments.

We invest in people and new advanced technologies to unlock the power of data. As a FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 22,500 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.

Description

General Summary of Duties: Responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.

Supervision Received: Reports to PARS Appeals Unit Manager.

Essential Functions:

• Implements process for identifying under-allowed claims using Contract Manager Product 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 Contract Manager application to track appeals and appeal outcomes.

• Establishes and cultivates helpful and effective contacts in payer or network offices.

• 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: Bachelors degree in related field, or equivalent education and experience.

Experience:

• Minimum of two years experience working with managed care claims and appeals for health care professional services (physicians and other health care professionals).

• Experience working with a Contract Manager application is a plus.

• Experience in a production environment is desirable but comfort in such an environment is essential.

• Experience with digital & remote office equipment

Knowledge:

• Advanced knowledge and PC skills, with proficiency in utilizing Microsoft office products (Word, Excel, Outlook, PowerPoint, etc.)

• Knowledge of the health care professional services billing (physicians and related health care professionals) and reimbursement environment.

• Knowledge of major types of practice management system (PMS) and EOB imaging systems, with experience working with at least one industry leading PMS highly desirable.

• Knowledge of medical terminology.

• Knowledge of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.

• Knowledge of managed care contracts and compliance.

Additional Information

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

Our benefits include: Medical, life and dental insurance, Asociación Solidarista, International Share Save Plan, Flex Work/Work from home, Paid time off, Annual Performance Bonus, Education Reimbursement, Family Bonding, Bereavement Leave, Referral Program, and more.

Experian is proud to be an Equal Opportunity and Affirmative Action employer. Our goal is to create a successful, inclusive and diverse team where people love their work and love working together. We believe that diversity, equity and inclusion is important to our purpose of creating a better tomorrow. We value the uniqueness 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.