Health Plan Appeal & Policy Analyst

AnMed; Anderson (SC); On-site; USD 55,000 - 90,000; Full time

Benefits offered by this job

Medical Insurance & Wellness Offerings

Compensation, Retirement & Financial •

Free Financial Counseling

Work-Life Balance & PTO

Professional Development

Job summary

AnMed in Anderson, South Carolina, is seeking a qualified professional to manage disputes on escalated claims, utilization management, and denials within our not-for-profit health system. The role involves reviewing health plan policy changes, maintaining contract inventories, and supporting reporting functions.

You will need strong Microsoft Office and EPIC experience, plus the ability to communicate clearly with internal stakeholders.

Qualifications

• Bachelor’s degree in Business Administration, Healthcare Administration or related field and 2-4 years experience in managed care.
• 8+ years of experience required without Bachelor’s degree;
• Proficiency in Microsoft Office (Excel and Word)
• Excellent communication/professional writing/interpersonal skills

Responsibilities

• Research Issues using EPIC, Health Plan Policies, guidelines & Tools, discussing with subject matter experts to develop appeal
• Prepare escalation grids for health plan and joint committees in a timely/accurate fashion
• Stay appraised on changes to health plan policies/guidelines & reporting to Health Plan Policy Changes group
• Identify areas of revenue reduction and operational inefficiencies
• Maintain minutes of HP Policy Changes group as well as Managed Care contracts Sharepoint site
• Administer Managed Care Contract Process, ensuring stakeholders are notified, EPIC Contract files are updated, and route tracker is maintained
• Perform stakeholder education sessions for Managed Care Contract Process

Skills

Excel

Word

Microsoft Office

Communication

Education

Bachelor’s degree

Tools

EPIC

Job description

Located in the heart of Anderson, South Carolina, AnMed is a dynamic, not-for-profit health system dedicated to delivering exceptional care with compassion, innovation, and integrity. At AnMed, our mission is simple yet powerful:

To provide exceptional and compassionate care to all we serve.

AnMed has been named one of the Best Employers in South Carolina by Forbes, reflecting our commitment to a supportive, inclusive, and purpose-driven workplace. Whether you're just starting your career or looking to grow in a new direction, you'll find opportunities to thrive, lead, and make a meaningful impact here.

Summary

Responsible for the resolution of disputes on escalated claims, utilization management, or other denials. Reviews any changes to health plans policy and procedures, recommending changes where appropriate. Maintains Managed Care contract inventory, reports, tracking grids and related processes.

Responsibilities

• Research Issues using EPIC, Health Plan Policies, guidelines & Tools, discussing with subject matter expertsto develop appeal
• Prepare escalation grids for health plan and joint committees in a timely/accurate fashion
• Stay appraised on changes to health plan policies/guidelines & reporting to Health Plan Policy Changes group
• Identify areas of revenue reduction and operational inefficiencies
• Maintain minutes of HP Policy Changes group as well as Managed Care contracts Sharepoint site
• Administer Managed Care Contract Process, ensuring stakeholders are notified, EPIC Contract files are updated,and route tracker is maintained
• Perform stakeholder education sessions for Managed Care Contract Process

Qualifications:

Bachelors Degree in Business Administration, Healthcare Administration or related field and 2-4 years experience in managed care, appeals, grievances, utilization management, or revenue cycle

8+ years of experience requiredwithoutBachelors degree;

Proficiency in Microsoft Office (Excel and Word)

Excellent communication/professional writing/interpersonal skills

Ability to manage time well, staying organized/meeting deadlines

• Medical Insurance & Wellness Offerings
• Compensation, Retirement & Financial Planning
• Free Financial Counseling
• Work-Life Balance & Paid Time Off (PTO)
• Professional Development

For more information, please visit: anmed.org/careers/benefits

*Varied benefits packages are available to positions with a 0.6 FTE or higher

About AnMed

Founded in 1908, AnMed is an independent, not-for-profit health system serving Upstate South Carolina and northeast Georgia. It is licensed for 648 beds and anchored by AnMed Medical Center, a 495-bed acute-care hospital that’s earned the prestigious Magnet designation from the American Nurses Credentialing Center since 2012. Also included are a heart and vascular center, a comprehensive cancer center, a maternity center, a behavioral health hospital, a rehabilitation hospital, and AnMed Integrated Therapy and AnMed Urgent Care locations. The AnMed Piedmont campus and its freestanding emergency department opened in 2025, and a new campus serving Clemson and Central is under construction and scheduled to open in 2027. Nearly 60 physician practices are also among service sites spread throughout the region. The system has 742 physicians on medical staff and more than 4,000 employees. Guided by core values of compassion, innovation, integrity, accountability and collaboration, AnMed was named one of the nation’s Great Community Hospitals by Becker’s Hospital Review. It’s also been named among the nation’s 165 top places to work in health care. It is one of three systems in the nation to earn the 2024 Carolyn Boone Lewis Equity of Care Award from the American Hospital Association. Learn more at AnMed.org.