Appeals Resolution Analyst
virtual vocationsNew York, NY
Appeals Resolution Analyst
virtual vocationsNew York, NYSenior L5
Administrative Law Judges, Adjudicators, and Hearing OfficersArbitrators, Mediators, and ConciliatorsRegulatory Affairs Specialists
All Other Miscellaneous Ambulatory Health Care ServicesGeneral Medical and Surgical HospitalsPharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
APPLY NOWResponsible for managing the end-to-end process of clinical appeals resolutions for Government Programs, the full-time Appeals Resolution Analyst will ensure compliance with timeliness and accuracy standards while working remotely.
Key responsibilities:
Handle the complete appeals process, including data entry, external reviews, and case completion
Communicate with providers and members regarding appeal statuses and processes
Collaborate with internal and external vendors to ensure compliance with regulatory standardsRequired qualificationsHigh School diploma or GED required; Bachelor's degree preferred
Minimum of one year of recent acute care medical-surgical or rehabilitation experience preferred
One year of utilization management experience preferred
Knowledge of healthcare delivery systems, CPT-4, and ICD-9 coding required
Experience with current medical management systems preferred
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Level
Senior L5
Location
New York, NY
Occupation
Administrative Law Judges, Adjudicators, and Hearing Officers
Industry
All Other Miscellaneous Ambulatory Health Care Services
Posted
2 days ago