APPEALS CLINICIAN – REMOTE

Submit your resume to careers@aergo.com

Please be sure to reference the position in your email.

Essential Duties and Responsibilities:

    • Analyze, interpret and load healthcare insurance contract data into Contract Management system.
    • Full understanding of Contract Management system hierarchy and load structure in order to create, modify and audit contract profiles and perform contract modeling.
    • Validate contract load results through detailed testing/review of patient account data.
    • Possess thorough understanding of existing and future managed care payment methodologies in order to effectively analyze managed care trends and make recommendations for continued revenue growth.
    • Research calculation methods, contract reimbursement terms and payment formulas.
    • Work directly with the client to provide high customer satisfaction.
    • Identify and document new service opportunities.
    • Update and maintain existing client contracts post-implementation.

Minimum Qualifications & Competencies:

    • BS/BA degree
    • 2+ years managed care analytics experience
    • Strong analytical skills with extreme attention to detail
    • Intermediate to advanced experience with Microsoft Excel, including pivot tables, formula calculations, and V-look ups required
    • Must possess excellent written and verbal communication skills
    • Experience in hospital managed care contract methodologies
    • Experience with Medicare reimbursement preferred
      2019