Healthcare Appeals Analyst

Seneca Resources; United States; Remote; USD 40,000 - 45,000; Full time

Job summary

A leading company in IT services is seeking a Healthcare Appeals Analyst to support federal clients. This remote role involves reviewing medical records and making independent decisions on appeals. Candidates should have relevant healthcare experience and be able to work independently. Join a team that values diversity and offers competitive compensation.

Qualifications

• 2-3 years of medical dispute resolution or Medicare appeals experience.
• Healthcare Professional with relevant experience or advanced degree.
• Demonstrated experience writing appeal or payment determinations.

Responsibilities

• Reviews medical records and writes dispute resolution decisions.
• Makes independent decisions based on medical evidence.
• Conducts research using federal regulations and medical literature.

Skills

Medical Dispute Resolution

Patient-Provider Dispute Resolution

Coding

Education

Associate’s Degree

Tools

Office 365

Excel

Word

Job description

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This range is provided by Seneca Resources. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$40,000.00/yr - $45,000.00/yr

Direct message the job poster from Seneca Resources

Lead Government Services Recruiter at Seneca Resources

We are seeking a Healthcare Appeals Analyst to support a contract with our federal client. This role provides dissatisfied patients/ beneficiaries and/or providers the opportunity to present documentation to demonstrate why an appeal/dispute should be allowed. It also provides an independent second level determination/dispute resolution based on the documentation, facts, laws, regulations, and guidelines.

This is a remote position that can be based anywhere in the United States.

Responsibilities

• Reviews medical records/case file, writes a reconsideration/dispute resolution decision that is clear, concise, and impartial and supports the determination made, and documents review
• Makes sound, independent decisions based on medical evidence in accordance with statutes, regulations, rulings, and policy
• Responds to and ensures that all appeal/dispute issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed
• Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures
• Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision
• Stays abreast of changes in regulations, medical and healthcare practices, policies and procedures
• Participates in case specific verbal discussions
• Conducts reviews of appeals/disputes with multiple beneficiaries/services in one case
• Plans responses to statistical analysis challenges with assistance from statisticians
• Attends meetings and participates in workgroups at the direction of management
• Conducts quality reviews, as needed
• Serves as a subject matter expert
• Mentors and/or trains staff
• May conduct quality reviews and audits
• Participates in special projects and performs other duties as assigned

Required Experience and Skills

• Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review, clinical, or related experience in a healthcare setting
• Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience. Juris Doctorate (JD) or Master’s Degree in Healthcare or related discipline may be substituted for Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
• Demonstrated experience writing or making appeal or payment determinations
• Patient-Provider Dispute Resolution, preferred
• Coding certificate, preferred
• Appeals and billing, preferred
• Experience using Office 365, including using Excel and Word
• Must be able to pass Federal and state criminal background checks, as required by client
• Must be able to pass drug screen, as required by client
• Ability to obtain a government clearance
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
• Experience working with/in the federal public health agency environment, preferred, but not required

Education and Training

• Associate’s degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline. Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate’s degree on a year per year basis (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent)

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer. May need to lift 25 pounds occasionally.

About Seneca Resources:

Seneca Resources is client driven provider of strategic Information Technology consulting services and Workforce Solutions to government and industry. Seneca Resources is a leading IT services provider with offices in Reston, Virginia, Alabama, and Columbia, Maryland that services clients throughout the United States. The key to our success lies within our strong corporate culture which drives our business. We challenge our staff through engaging work, and we reward our staff through competitive compensation, extensive professional training, and excellent opportunities for career advancement. In turn, we look for only the best and brightest to join our team. We are an Equal Opportunity Employer and value the benefits of diversity in our workplace.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Contract

Job function

• Job function

  Other

• Industries

  IT Services and IT Consulting

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