• Appeals Analyst

    Motion Recruitment Partners (Durham, NC)


    Appeals Analyst

     

    Durham, North Carolina

     

    100% Remote

     

    Contract

     

    $20/hr - $25/hr

     

    Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Appeals Analyst. They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs.

     

    **Location:** ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

     

    Contract Duration: 12 Months, Contract to Hire

    Required Skills & Experience

    + Bachelor’s degree or advanced degree where required.

    + 3 years of related experience

    + In lieu of degree, 5 years of related experience

    + Must be CPC Certified

    Desired Skills & Experience

    + Care Radius a plus

    + Facets a plus

    What You Will Be Doing

    + Analyze, research, resolve and respond to confidential/sensitive appeals, coding disputes, grievances and coverage/organization determinations from members, member's representatives, providers, media outlets, senior leadership andregulatory agencies with established regulatory and accreditation guidelines.

    + Analyze, interpret, and explain health plan benefits, policies, procedures, medical terminology, coding and functions to members and/or providers.

    + Regularly and independently exercise judgement to make appropriate decisions based on clients policies and guidelines. Acts decisively to ensure business continuity and with awareness of all possible implications and impact.

    + Prepare files and develops clients position statements for external reviews performed by independent review organizations, benefit panels and external medical consultants.

    + Provide comprehensive appeals, coding disputes and grievances responses that support the decision and comply with regulatory and accreditation guidelines.

    + Document extensive investigation, relative findings, and actions in all applicable systems

    + Accountable for monitoring daily reports to ensure service timeliness and compliance is met.

    + Gather clinical information by using established criteria provided in corporate medical policies; partner with Medical Directors who are responsible for all decisions regarding clinical appeals/grievances.

    + Ensures timeliness, quality, and efficiency in all work to comply with applicable mandated State (NCDOI) and/or Federal (Centers for Medicare & Medicaid Services (CMS), ERISA, etc.) accreditation agency standards (National Committee for Quality Assurance – NCQA), ASO group performance guarantees and policies and procedures (to include clients requirements).

    ****To be eligible to contract at this client you must be able to pass a drug test and criminal background check

    You will receive the following benefits:

    + Medical Insurance - Four medical plans to choose from for you and your family

    + Dental & Orthodontia Benefits

    + Vision Benefits

    + Health Savings Account (HSA)

    + Health and Dependent Care Flexible Spending Accounts

    + Voluntary Life Insurance, Long-Term & Short-Term Disability Insurance

    + Hospital Indemnity Insurance

    + 401(k) including match with pre and post-tax options

    + Paid Sick Time Leave

    + Legal and Identity Protection Plans

    + Pre-tax Commuter Benefit

    + 529 College Saver Plan

     

    Motion Recruitment Partners (MRP) is an Equal Opportunity Employer. All applicants must be currently authorized to work on a full-time basis in the country for which they are applying, and no sponsorship is currently available. Employment is subject to the successful completion of a pre-employment screening. Accommodation will be provided in all parts of the hiring process as required under MRP’s Employment Accommodation policy. Applicants need to make their needs known in advance.

     

    **Posted by:** Andrew Chadwick

    Specialization:

    + Medical / Healthcare Professional