Hybrid Provider Payment Appeal Analyst

Posted last month

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About the role

  • Support the Payment Dispute process across all lines of business and resolve Provider Payment Appeal requests
  • Review and analyze provider requests to investigate the outcome of a Reconsideration
  • Consider all information when determining whether to uphold or overturn primary decision
  • Work with various departments including Provider Solutions and Health Plan Operations leadership to determine root cause and appropriate resolution
  • Work with Claims Operations to remediate impacted claims
  • Virtual role with required in-person training sessions and potential hybrid onsite requirements per company policy

Requirements

  • HS diploma or GED
  • Minimum of 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry
  • or any combination of education and experience which would provide an equivalent background
  • Bachelor's degree preferred
  • Claims processing experience preferred
  • WGS/CI&W experience preferred
  • Must be within a reasonable commuting distance from the posting location(s) unless an accommodation is granted as required by law
  • Candidates in certain patient/member-facing roles required to become vaccinated against COVID-19 and Influenza (offer rescinded if not vaccinated unless acceptable explanation)

Benefits

  • a comprehensive benefits package
  • incentive and recognition programs
  • equity stock purchase and 401k contribution
  • merit increases
  • paid holidays
  • Paid Time Off
  • incentive bonus programs
  • medical, dental, vision
  • short and long term disability benefits
  • 401(k) +match
  • stock purchase plan
  • life insurance
  • wellness programs
  • financial education resources

Job title

Provider Payment Appeal Analyst

Job type

Experience level

Mid levelSenior

Salary

$23 - $41 per hour

Degree requirement

High School Diploma

Location requirements

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