Appeals Analyst

Position Summary:

• The Appeals Analyst investigates denied claims, documents investigation, and works to effect reimbursement for denied services.
• Requires strong understanding of clinical policies, contracts, and regulations to guide research into claim denials.

Essential Duties:

• Resolve claims by reviewing supporting documentation, calculating benefits, initiating payment, and composing appeal letters.
• Analyze claims to determine validity of denial/recovery options and draft detailed correspondence to effect reimbursement.
• Work individually and within a team to identify trends from client inventories and formulate recovery resolutions.

Qualifications:

• High school diploma required; Associate's degree or higher preferred.
• 2-4 years of experience in appeal and claim processing.
• Strong verbal and written communication, customer service, analytical, and negotiation skills.

Work Environment:

• Remote role with travel to home offices in TN for training.
• Minimal physical risks, mostly sedentary work with occasional walking or standing.