Remote Healthcare Appeals Analyst

Valenz Group; Oregon; Hybride; USD 65 000 - 90 000; Plein temps

Avantages offerts par ce poste

Medical Insurance

Dental Insurance

Vision Insurance

HSA/FSA

401K

Flexible work

Paid time off

EAP

Maternity/Paternity leave

Pet insurance

Employee discounts

Community giveback

Résumé du poste

Valenz Health is seeking an Appeals Analyst to review provider appeals, apply SOPs, and determine accurate claim resolutions. You will calculate settlements, draft agreements, and coordinate denials when appropriate, while ensuring compliance with ERISA and state/federal rules.

The role emphasizes documentation, collaboration with clients, and effective use of Zendesk and MS tools to manage cases and communications. Remote work is offered with HIPAA compliance requirements.

Qualifications

• 2+ years of healthcare claims, provider appeals, reimbursement, revenue cycle, or medical billing experience.
• Knowledge of CPT-4, HCPCS, Revenue Codes, DRG, and ICD-10 coding for accurate claims review and pricing.
• Knowledge of No Surprise Act, ERISA, and related legislation.
• Detail-oriented with ability to identify discrepancies and ensure accurate results.
• Experience reviewing out-of-network claim appeals and using pricing tools to assess reimbursement.
• Knowledge of Medicare reimbursement methodologies.
• Ability to interpret contracts and plan documents for accurate adjudication.

Responsabilités

• Review appeals from providers adhering to SOPs and SLAs, with timely communication to clients and providers.
• Compare reimbursements against plan documentation, network agreements, and contract requirements for in- and out-of-network appeals.
• Calculate and propose initial settlement offers based on claim history and data.
• Prepare and forward agreement templates detailing negotiated terms.
• Support compliance with ERISA and federal/state regulations.
• Maintain documentation of appeal research, negotiations, and outcomes.
• Record finalized agreements for future reference and compliance.
• Communicate regularly with clients about appeal statuses and outcomes.
• Prepare denial determinations per policies and guidelines.

Connaissances

Healthcare claims knowledge

Attention to detail

Communicate effectively

Remote work readiness

Formation

Healthcare administration degree

Outils

Zendesk

Microsoft Outlook

Microsoft Teams

Excel

Description du poste

Valenz Health is seeking an Appeals Analyst to review provider appeals, apply SOPs, and determine accurate claim resolutions. You will calculate settlements, draft agreements, and coordinate denials when appropriate, while ensuring compliance with ERISA and state/federal rules.

The role emphasizes documentation, collaboration with clients, and effective use of Zendesk and MS tools to manage cases and communications. Remote work is offered with HIPAA compliance requirements.