Medicare Appeal AnalystPrimary Location: Cranberry, PA
Additional Locations: PA-Cranberry Apply
- Identify correct resource and reroute inappropriate work items that do not meet appeal criteria.
- Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process.
- Responsible for coordination of all components of complaints/appeals including final communication to member/provider for final resolution and closure.
- Identifies trends and emerging issues and reports on and gives input on potential solutions.
- Follow up to assure complaint/appeal is handled within established timeframes to meet company and regulatory requirements.
- 1-2 years of professional work experience within various backgrounds including but not limited to: Customer Service (Office or Customer Facing), Administrative, Clerical, and Healthcare operations experience.
- Experience with Microsoft Excel, Word, and Outlook
- Experience in research and analysis of claim processing a plus.
- Some college preferred. High School or GED equivalent.
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