Appeals Analyst

Pyramid Consulting, Inc; Durham (NC); On-site; USD 34,000 - 39,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Paid sick leave

Job summary

Pyramid Consulting, Inc. is seeking an Appeals Analyst for a 06+ months contract in Durham, NC onsite. The role focuses on analyzing appeals and disputes, explaining health plan benefits, and preparing statements for external reviews.

Collaboration with Medical Directors is required to gather clinical information and ensure regulatory compliance. Ideal candidates have 3+ years of related experience (5+ years if no degree) and a Bachelor’s or higher.

Qualifications

• 3+ years of related experience; 5+ years if no degree.
• Bachelor's degree or higher is required where applicable.
• Certified coder within 1 year is preferred for coding disputes.

Responsibilities

• Analyze and respond to appeals, coding disputes, and grievances from members, providers, and regulatory agencies.
• Explain health plan benefits, policies, and medical terminology to stakeholders.
• Prepare position statements for external reviews and document investigations thoroughly.
• Collaborate with Medical Directors to gather clinical information for appeals and grievances.
• Ensure compliance with state and federal accreditation standards and policies.
• Monitor daily reports to maintain timeliness and compliance.

Skills

3+ years experience

5+ years experience in lieu of degree

Education

Bachelor’s degree or higher

Job description

Immediate need for a talented Appeals Analyst. This is a 06+months contract opportunity with long-term potential and is located in Durham,NC(Onsite).

Job ID:26-32226

Pay Range: $25 - $28/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Analyze and respond to appeals, coding disputes, and grievances from members, providers, and regulatory agencies.
• Interpret and explain health plan benefits, policies, and medical terminology to stakeholders.
• Prepare position statements for external reviews and document investigations thoroughly.
• Collaborate with Medical Directors to gather clinical information for appeals and grievances.
• Ensure compliance with state and federal accreditation standards and organizational policies.
• Monitor daily reports to maintain service timeliness and compliance.

Key Requirements and Technology Experience:

• 3+ years of related experience; in lieu of a degree, 5+ years of related experience.
• Bachelor’s degree or advanced degree where required.
• For coding disputes, a certified professional coder must be obtained within 1 year of employment.

Our client is a leading Insurance Industry, and we are currently interviewing to fill this and other similar contract positions.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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