Full-time
Employee Status: Regular
Role Type: Hybrid
Department: Healthcare
Schedule: Full Time
**Company Description**:
- Our mission is to use data driven insights to simplify healthcare for all. Simply put, we want to make the healthcare system work better for us as consumers and for those who work in healthcare. Our ONE Experian Health culture is the centerpiece of making this happen. Our aspiration is to bring people together who are driven by purpose and want to make a difference. We strive to have a diverse group of people and minds who are:_
- **_ O_**_PEN: _**_Have a growth mindset and collaborate often with others to make things happen_
- **_ N_**_IMBLE: _**_Always embracing change and pushing the envelope on innovative ways to solve problems_
- **_ E_**_FFECTIVE: _**_Accountable to themselves and to others_
The Healthcare Appeals Analyst is responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.
**Essential Functions**:
- Implements process for identifying under-allowed claims using software 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 software to track appeals and recoveries.
- Establishes and cultivates helpful and effective contacts in payer or network offices.
- Establishes follow-up protocol with payers and networks.
- Prepares monthly performance statistics regarding appeals and recoveries.
- 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 and Experience**:
- High School completed and with some university studies preferred.
- Minimum of 1-2 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.
- Equivalent combination of education and experience may be considered
**Knowledge**:
- 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.
**Skills**:
- Demonstrated skill in gathering and reporting claims information.
- Demonstrated skill in written and oral communication with colleagues, supervisors, and payer/network personnel.
- Demonstrated skill working in a team-oriented structure to achieve goals.
- Demonstrated skill in problem solving and research.
**Abilities**:
- Ability to work effectively with other departments and management.
- Ability to identify, analyze and solve problems and to recognize patterns in data.
**Additional Information**:
***This is a permanent home-based role in Costa Rica. No Visa sponsorship or relocation available.**
Our goal is to create a thriving, inclusive and diverse team where people love their work and love working together. 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. For us, this is The Power of YOU and it ensures that we live what we believe.
- All your information will be kept confidential according to EEO guidelines. Experian is proud to be an Equal Opportunity and Affirmative Action employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. _
- The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies._
- EOE including Disability/Veterans_
