APPEALS CLINICIAN – REMOTE
Submit your resume to email@example.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