Appeals Analyst , Healthcare ( San Antonio, TX )

Job Description

The Healthcare Appeals Analyst is responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.
Core Responsibilities:

• Implements process for identifying under-allowed claims using Contract Manager and other available tools.
• Reviews and analyzes EOBs for identified under-allowed claims.
• Verifies applicable contract by, as dictated by operational procedures: reviewing EOB messages, reviewing patient ID card, verifying member information for managed care plans.
• Batches appeals by payer or network, by CPT/HCPCS code combination, by error type, or by provider.
• Compiles and submits appeals, and monitors for proper reimbursement.
• Uses Contract Manager to track appeals and recoveries. Prepares monthly performance statistics regarding appeals and recoveries.
• Monitors and tracks contractual, billing, registration, and posting errors, and provides continuous feedback to Appeals Manager.

Education and Experience:

• Bachelors degree or greater in related field, or equivalent education and experience.
• Minimum of two years experience working with managed care claims and appeals for health care professional services (physicians and other health care professionals).
• Experience in a production environment desirable but comfort in such an environment is essential.

Knowledge:

• The health care professional services billing (physicians and related health care professionals) and reimbursement environment required.
• Major types of practice management system (PMS) and EOB imaging systems, with experience working with at least one industry leading PMS highly desirable.
• Medical terminology.
• Networks, IPAs, MSOs, HMOs, PCP and contract affiliations.
• Managed care contracts and compliance.

Experian is the leading global information services company, providing data and analytical tools to our clients around the world. We have always believed that data has the potential to transform lives and create a better tomorrow. We are transforming data into something meaningful: helping businesses to manage credit risk, preventing fraud, targeting marketing offers and automating decision making. We have been named one of the “World’s Most Innovative Companies” by Forbes for 3 years in a row, operating at the center of Big Data since before the phrase was coined. Few companies can offer information services on an equivalent scale. We support clients in more than 80 countries and employ approximately 17,000 people in 37 countries.
Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.

EOE including Disability/Veterans