Appeals Analyst Position Available In Durham, North Carolina
Tallo's Job Summary: The Appeals Analyst role in Durham, NC offers a contract position with an estimated salary of $50.8K - $62K a year. The job requires 3 years of experience, a Certified Professional Coder certification, and a Bachelor's degree. Responsibilities include analyzing and responding to appeals, coding disputes, and grievances, ensuring compliance with regulatory guidelines. ManpowerGroup is hiring for this position.
Job Description
Appeals Analyst Experis
- 3.
3
Durham, NC Job Details Contract Estimated:
$50.8K
- $62K a year 15 hours ago Qualifications Employment & labor law Mid-level 3 years Certified Professional Coder Bachelor’s degree Full Job Description Our client is seeking Appeal Analyst a to join their team.
Appeal Analyst Contract to
Hire Remote Responsibilities:
Analyze, research, resolve and respond to confidential/sensitive appeals, coding disputes, grievances and coverage/organization determinations from members, member’s representatives, providers, media outlets, senior leadership and regulatory agencies with established regulatory and accreditation guidelines. Analyze, interpret, and explain health plan benefits, policies, procedures, medical terminology, coding and functions to members and/or providers. Regularly and independently exercise judgement to make appropriate decisions based on BlueCross NC policies and guidelines. Acts decisively to ensure business continuity and with awareness of all possible implications and impact. Prepare files and develops BlueCross NC position statements for external reviews performed by independent review organizations, benefit panels and external medical consultants. Provide comprehensive appeals, coding disputes and grievances responses that support the decision and comply with regulatory and accreditation guidelines. Document extensive investigation, relative findings, and actions in all applicable systems Accountable for monitoring daily reports to ensure service timeliness and compliance is met. Gather clinical information by using established criteria provided in corporate medical policies; partner with Medical Directors who are responsible for all decisions regarding clinical appeals/grievances. Ensures timeliness, quality, and efficiency in all work to comply with applicable mandated State (NCDOI) and/or Federal (Centers for Medicare & Medicaid Services (CMS), ERISA, etc.) accreditation agency standards (
National Hiring Requirements:
Bachelor’s degree or advanced degree where required. 3 years of related experience In lieu of degree, 5 years of related experience CPC required If this is a role that interests you and you’d like to learn more, click apply now and a recruiter will be in touch with you to discuss this great opportunity. We look forward to speaking with you!
About ManpowerGroup, Parent Company of:
Manpower, Experis, Talent Solutions, and Jefferson Wells ManpowerGroup® (
NYSE:
MAN), the leading global workforce solutions company, helps organizations transform in a fast-changing world of work by sourcing, assessing, developing, and managing the talent that enables them to win. We develop innovative solutions for hundreds of thousands of organizations every year, providing them with skilled talent while finding meaningful, sustainable employment for millions of people across a wide range of industries and skills. Our expert family of brands
- Manpower, Experis, Talent Solutions, and Jefferson Wells
- creates substantial value for candidates and clients across more than 75 countries and territories and has done so for over 70 years. We are recognized consistently for our diversity
- as a best place to work for Women, Inclusion, Equality and Disability and in 2022 ManpowerGroup was named one of the World’s Most Ethical Companies for the 13th year
- all confirming our position as the brand of choice for in-demand talent.
