Appeals Analyst - Experian Health - Remote

Company Description

Experian is a global data and technology company, powering opportunities for people and businesses around the world. We help to redefine lending practices, uncover and prevent fraud, simplify healthcare, create marketing solutions, and gain deeper insights into the automotive market, all using our unique combination of data, analytics and software. We also assist millions of people to realize their financial goals and help them save time and money.

We operate across a range of markets, from financial services to healthcare, automotive, agribusiness, insurance, and many more industry segments.

We invest in people and new advanced technologies to unlock the power of data. As a FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 22,500 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.

Job Description

At Experian Health, our employees can shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. https://www.experian.com/healthcare/

The Appeals Analyst will report to the Client Organization. You will monitor contractual allowances, analyze and pursue appeal opportunities with payers and networks and report appeals performance.

You'll have the opportunity to:

• Implement processes for identifying under-allowed claims using Experian Health Contract Manager Product and other available tools
• Review and analyze EOBs for identified under-allowed claims
• Verify applicable contract as dictated by operational procedures: reviewing EOB messages
• Review patient ID card, verifying member information for managed care plans
• Batch appeals by payer or network, by CPT/HCPCS code combination, by error type, or by provider
• Compile and submit appeals, and monitor for proper reimbursement
• Utilize Contract Manager application to track appeals and appeal outcomes
• Establish and cultivate contacts in payer or network offices
• Track contractual, billing, registration, and posting errors, and provide feedback to Appeals Manager
• Participate in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts
• Maintain the strict confidentiality required for medical records and other data
• Participate in professional development efforts to ensure currency in managed care reimbursement trends

Qualifications

• 2+ years' experience working with managed care claims and appeals for health care professional services (physicians and other health care professionals)
• 1+ years' experience with a healthcare contract manager application
• 2+ years experience with healthcare professional services billing (physicians and related health care professionals) and reimbursement environment
• Knowledge of major types of practice management system (PMS) and EOB imaging systems, with experience working with at least one industry leading PMS and of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.as well as managed care contracts and compliance.

Benefits/Perks:

• Great compensation package and bonus plan
• Core benefits including medical, dental, vision, and matching 401K
• Flexible work environment, ability to work remote
• Flexible time off including volunteer time off, vacation, sick and 12-paid holidays

Additional Information

Our uniqueness is that we celebrate yours. Experian's culture and people are important differentiators. We take our people agenda very seriously and focus on what matters; DEI, work/life balance, development, authenticity, collaboration, wellness, reward & recognition, volunteering... the list goes on. Experian's people first approach is award-winning; World's Best Workplaces™ 2024 (Fortune Top 25), Great Place To Work™ in 24 countries, and Glassdoor Best Places to Work 2024 to name a few. Check out Experian Life on social or our Careers Site to understand why.

Experian is proud to be an Equal Opportunity and Affirmative Action employer. Innovation is an important part of Experian's DNA and practices, and our diverse workforce drives our success. Everyone can succeed at Experian and bring their whole self to work, irrespective of their gender, ethnicity, religion, colour, sexuality, physical ability or age. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.