Health Care Claims Appeals Analyst - 5 Months' Contract (63810)

HEALTH CARE CLAIMS APPEALS ANALYST

CONTRACT: 6 months (W2)

LOCATION: Burbank, CA

JOB NUMBER: 63810

CLIENT: One of the country's largest health care and health plan providers

POSITION DESCRIPTION:

- The Appeals Analyst triages all incoming correspondence to determine whether claim meets appeal/dispute criteria.
- Assists in the facilitation of the grievance and appeal process by investigation, documentation to ensure completion.
- Support the administrative requirements of the department by maintaining files, reports, and other duties as assigned.

ESSENTIAL FUNCTIONS:

- Determines whether incoming correspondence meets appeal/dispute criteria; conducts additional research to clarify intent of request
- Assigns to appropriate Appeals Specialist
- Develops a clear, concise, and highly accurate facilitation of correspondence (via mail, email, telephone, fax, worklist)
- Input appeal/dispute in system of record using appropriate tracking system guidelines
- Prepare written response letters for member appeals
- Answers all telephone inquiries; responds to customers appropriately regarding inquiries
- Schedule member participation for both clinical and non-clinical grievance rounds
- Prepare and distribute grievance cases for review at rounds; may schedule/reserve conference rooms
- Perform special assignments/projects such as compiling cases for audits/management reports
- Ensure department maintains adequate materials/supplies and initiates orders as necessary
- Maintain department's documentation requirements
- Understand compliance and claims payer requirements including Medicare and Medicaid
- Review all assigned cases to determine priority
- Adheres to all quality, compliance and regulatory standards to achieve best outcomes
- Responds to and resolves cases within designated regulatory timelines as identified by case/payer type
- Serve as liaison between Claims, members, regulatory agencies, state program, and providers
- Identifies barriers to work processes and brings to the attention of the supervisor/manager

REQUIRED EDUCATION, EXPERIENCE, AND SKILLS:

- High School diploma or GED required; Associate's degree preferred
- Minimum 2 years' experience in medical claims, insurance claims, and/or appeals
- Intermediate competency in Microsoft Office
- Excellent writing skills and the ability to express ideas concisely and clearly orally and in writing
- High degree of independent judgment, speed, and accuracy