| Our team is growing, and we currently have an immediate opening for a Medical Claims Appeals Analyst (REMOTE)
Title
Medical Claims Appeals Analyst (Full Time) Location
REMOTE Reports To
Billing Manager Job Overview
Responsible for all medical records submission and Appeals & Grievances processes of insurance reimbursement along with accounts receivable follow-up on aged claims.
Essential Duties & Responsibilities - Ensure grievance & appeals cases are accurate, including necessary elements for processing/resolving, giving special attention to those identified as “Expedite”
- Create clear & concise documentation in applicable electronic software system(s)
- Identify all issues/required actions within a case; categorize cases & identify required actions in accordance with state and federal regulations
- Create/manage documents, correspondence & reports, including acknowledging cases, resolving cases, monitoring effectuation of resolution, completing resolution letters & communicating within required regulatory timeframes
- Develop effective & professional working relationships with internal & external stakeholders and partners, orally and in writing
- Contact members/providers for additional information or clarification for grievance or appeals cases; review & resolve issues by requesting medical records, Appointment of Representative, or any other pertinent information related to grievances & appeals from medical groups, delegated entities and/or providers
- Perform complete, accurate, consistent data entry into system software applications in accordance with policies/procedures
- Assist with telephone inquiries from patients, providers and sales executives.
- Assist the Billing Manager and Director of Billing & Reimbursement and peers with special projects; work collaboratively and cross-functionally with other departments to facilitate appropriate deadlines & resolutions and accomplish department objectives
- Create invoices for direct billing clients and manage those relationships.
- Perform other related duties as required or assigned
Qualifications: - Associates Degree in Business Administration or Health Information Management preferred, or, equivalent work experience of 4 years in Revenue Cycle Management
- Experience of 4 - 6 years in processing Health Insurance claims (Out-of-network experience preferred)
- Must have 2 years’+ experience in Appeals & Grievances in a Medicare Advantage setting.
- Laboratory experience preferred
- Experience with AdvancedMD and/or Quadax software preferred
- Microsoft Excel proficiency
- Solid analytical, mathematical & research skills
- Excellent communication interpersonal skills (written and verbal)
- Strong attention to detail & highly organized
- Ability to handle multiple demands & respond rapidly to changing priorities
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Cleveland Diagnostics, Inc., is developing highly efficacious, lab-friendly, affordable diagnostics tests using proprietary technology to improve cancer diagnostics. Its portfolio of non-invasive diagnostics will be expanding from prostate cancer to breast cancer and lung cancer. We pride ourselves in fostering a family-focused, friendly, and flexible organization that places our employee’s well-being and happiness as the primary reason for our success. Are you interested in building your career with a team of industry professionals while making a lasting impact to the lives of millions of people? Bring your talents to Cleveland Diagnostics.
Cleveland Diagnostics offers an extremely robust benefits package which includes: - 100% Employer-paid medical for single coverage effective on your date of hire and 50% employer-paid medical for spouse/dependent coverage
- 100% Employer-paid Dental & Vision for entire family
- No cost for employee coverage for Group Term Life, Short & Long Term Disability
- 4% retirement contribution Employer match
- Incentive Performance Plan & Stock Option Program & Commission (Sales Account Execs)
- Paid Family Leave Program
- Generous PTO plan & holiday program
- Flexible work schedule & lucrative employee referral program
- Salary range may vary by work state/geographical region/territory
- Easy to get to office location with newly built-out office space
- Free coffee, snacks and other goodies all day long
Cleveland Diagnostics is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because that is what drives curiosity, innovation, and the success of our business. EEO is the Law. Applicants can learn more about the company’s status as an equal opportunity employer by viewing the federal EEO is the Law poster on our careers page. Accommodations are available for applicants with disabilities.
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