• Health Plan Appeal & Policy Analyst

    AnMed Health (Anderson, SC)


    Located in the heart of Anderson, South Carolina, AnMed is a dynamic, not-for-profit health system dedicated to delivering exceptional care with compassion, innovation, and integrity. At AnMed, our mission is simple yet powerful:

     

    To provide exceptional and compassionate care to all we serve.

     

    AnMed has been named one of the Best Employers in South Carolina by Forbes, reflecting our commitment to a supportive, inclusive, and purpose-driven workplace. Whether you're just starting your career or looking to grow in a new direction, you'll find opportunities to thrive, lead, and make a meaningful impact here.

    Summary

    Responsible for the resolution of disputes on escalated claims, utilization management, or other denials. Reviews any changes to health plans policy and procedures, recommending changes where appropriate. Maintains Managed Care contract inventory, reports, tracking grids and related processes.

    Responsibilities

    -Research Issues using EPIC, Health Plan Policies, guidelines & Tools, discussing with subject matter experts to develop appeal

     

    -Prepare escalation grids for health plan and joint committees in a timely/accurate fashion

     

    -Stay appraised on changes to health plan policies/guidelines & reporting to Health Plan Policy Changes group

     

    -Identify areas of revenue reduction and operational inefficiencies

     

    -Maintain minutes of HP Policy Changes group as well as Managed Care contracts Sharepoint site

     

    -Administer Managed Care Contract Process, ensuring stakeholders are notified, EPIC Contract files are updated,and route tracker is maintained

     

    -Perform stakeholder education sessions for Managed Care Contract Process

    Qualifications:

    Bachelors Degree in Business Administration, Healthcare Administration or related field (required)

     

    2-4 years experience in managed care, appeals, grievances, utilization management, or revenue cycle

     

    Proficiency in Microsoft Office (Excel and Word)

     

    Excellent communication/professional writing/interpersonal skills

     

    Superior analytical, investigation & problem solving skills

     

    Ability to manage time well, staying organized/meeting deadlines

    Benefits*

    • Medical Insurance & Wellness Offerings

    • Compensation, Retirement & Financial Planning

    • Free Financial Counseling

    • Work-Life Balance & Paid Time Off (PTO)

    • Professional Development

    • For more information, please visit: anmed.org/careers/benefits

    *Varied benefits packages are available to positions with a 0.6 FTE or higher