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Appeals Analyst - Franklin, United States - XSOLIS, Inc.
Description
Position Summary
The Appeals Analyst will work with our clients and client representatives to investigate denied claims, document investigation, and work to effect reimbursement for denied services.
The Appeals Analyst will need a strong understanding of clinical policies, contracts, and regulations to guide research into claim denials.
Aside from the technical know-how, a successful Appeals Analyst will also have the soft-skills necessary to build relationships with clients, payers, and providers and the ability to draft a convincing argument for reimbursement.
Essential Duties and ResponsibilitiesThe essential functions include, but are not limited to the following:
Ability to resolve claims by reviewing supporting documentation; calculating benefits due; initiating payment or composing appeal letters; guiding resolution of non-routine claims; auditing claims to ensure appropriate payment.
Prepares reports by securing analytical information through to a finished product
Analyze claims to determine validity of denial/recovery options
Draft detailed & convincing correspondence to effect reimbursement
Develop relationships with insurance carriers, patients, attorneys, and employers to facilitate reimbursement
Conduct research when necessary to build a strong reimbursement argument
Research/Review clinical policies, contracts, and other media to aide in claims recovery.
Work individually and within a team to identify trends from client inventories and formulate recovery resolution
Clearly and concisely document all actions taken to resolution within a claims recovery system
Ensures legal compliance by following guidelines, contracts, regulations, and the company's business plan
Maintains quality service by following corporate provider and payer service practices and protocols
Minimum Qualifications (Knowledge, Skills, and Abilities)
High school diploma required; Associate's degree or higher preferred
2-4 years of experience in appeal and claim processing
Verbal and written communication
Customer service
Analytical skills
MS Office Suite
Negotiation, problem recognition, and resolution skills
Ability to multi-task
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position.
Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments.
All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities.
To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently.Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others.
The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an "at will" relationship.
