Appeals Analyst

Mindlance; Durham (NC); Remote; USD 60,000 - 100,000; Full time

Job summary

This innovative firm offers a contract-to-hire position in health insurance, providing an opportunity for career advancement and remote work flexibility. The role involves analyzing confidential appeals and interpreting health plan benefits, making a meaningful impact on member satisfaction. With a supportive team environment, you will utilize your analytical and organizational skills to ensure compliance and enhance service quality. If you're passionate about healthcare and looking for a chance to grow within a collaborative organization, this opportunity is perfect for you.

Qualifications

• Bachelor’s degree or CPC certification required.
• Minimum of 3 years of related experience or 5 years without a degree.

Responsibilities

• Analyze and resolve confidential appeals and coding disputes.
• Document findings to ensure compliance and service timeliness.

Skills

Analytical Skills

Organizational Skills

Decision-Making Skills

Communication Skills

Education

Bachelor's Degree

CPC Certification

Tools

Care Radius

Facets

Job description

Employer Industry: Health Insurance Services

Why consider this job opportunity:
- Contract-to-hire position with a potential for long-term employment
- Opportunity for career advancement and growth within the organization
- Work remotely from one of the 28 specified states
- Competitive salary based on experience
- Supportive and collaborative work environment with a large team
- Chance to make a meaningful impact on member satisfaction and compliance

What to Expect (Job Responsibilities):
- Analyze, research, resolve, and respond to confidential appeals, coding disputes, grievances, and coverage determinations from various stakeholders
- Interpret and explain health plan benefits, policies, and medical terminology to members and providers
- Exercise independent judgment to make decisions based on company policies and guidelines
- Prepare position statements for external reviews performed by independent organizations and medical consultants
- Document investigations and findings in applicable systems to ensure compliance and service timeliness

What is Required (Qualifications):
- Bachelor’s degree or advanced degree where required
- Minimum of 3 years of related experience
- In lieu of a degree, a minimum of 5 years of related experience
- CPC (Certified Professional Coding) certification required
- Strong desk management and organizational skills

How to Stand Out (Preferred Qualifications):
- Experience with Care Radius and Facets systems
- Ability to work effectively within a large team environment
- Familiarity with regulatory and accreditation guidelines related to health insurance
- Strong analytical and decision-making skills
- Experience in healthcare appeals and grievances processing

#HealthInsurance #RemoteWork #CareerOpportunity #CPCCertification #EqualOpportunityEmployer

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