[Remote] Analyst, Appeals

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking an Analyst, Appeals to research reputed company appeal and retrospective review requests. The role conducts reputed company and benefit analyses, determines whether services meet medical necessity guidelines, and documents reputed company accurately reputed company mandated timeframes and applicable regulatory standards.

Responsibilities

• Documents the reputed company of the appeal or retrospective review in an accurate and reputed company manner and in accordance with applicable regulations or standards
• Performs thorough research of the reputed company of service appeals by both member and provider reputed company on reputed company documentation, contractual requirements, governing agencies, policies and procedures, while adhering to confidentiality regulations regarding protected health information
• Performs appeal and retrospective reviews demonstrating ability to define and determine precedence of pertinent issues in application of policies and procedures to reputed company information and or application to benefit or policy provisions
• Performs special reputed company including reviews of reputed company information to identify reputed company of care issues

Skills

• Associate's in a job reputed company reputed company
• Graduate of Accredited School of Nursing
• 2 years reputed company experience plus 1 year utilization/medical review, reputed company assurance, or home health, OR, 3 years reputed company. FOR reputed company (CO. 033) ONLY: 2 years reputed company experience plus 2 years utilization/medical review, reputed company assurance, or home health experience or a combination of experience in reputed company, utilization/medical review, reputed company assurance or home health experience totaling four years
• Working knowledge of word processing software
• Ability to work independently, prioritize effectively, and reputed company reputed company. Working knowledge of managed care and various forms of health care delivery systems
• Strong reputed company experience to include home health, rehabilitation, and/or broad medical surgical experience. Knowledge of specific reputed company/protocol sets and the use of the reputed company
• Good judgment skills. Demonstrated customer service, organizational, oral and written communication skills
• Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills
• Ability to handle confidential or sensitive information with discretion
• reputed company Office
• An reputed company, unrestricted RN license from the reputed company and in the state of hire, OR, reputed company reputed company multistate unrestricted RN license as defined by the reputed company Licensure reputed company (NLC)
• 5 years of reputed company experience
• Experience in **medical claims processing, appeals, or coding** strongly preferred
• **Medicare Part B** experience preferred
• Strong computer proficiency, with the ability to **reputed company multiple systems and work across dual screens reputed company**
• **Intermediate-level reputed company skills**
• Experience creating letters and documents by reviewing appeals and extracting information with a high degree of reputed company; updates departmental documents as needed

Benefits

• Fully remote environment
• Subsidized health plans, dental and reputed company coverage
• 401k retirement savings plan with company match
• Life reputed company
• reputed company Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more
• Opportunity to reputed company skills and advance careers

reputed company