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Appeals Analyst
Chicago, IL
Job Description
APPEALS ANALYST
POSITION SUMMARY:
The Appeals Analyst is responsible for monitoring and tracking the status of appeals as they relate to Allied's Cost Containment program. The position involves reviewing appeals for appropriateness, documenting the claim specifics into the current software and routing documentation to business partners for review/resolution.
ESSENTIAL FUNCTIONS:
POSITION SUMMARY:
The Appeals Analyst is responsible for monitoring and tracking the status of appeals as they relate to Allied's Cost Containment program. The position involves reviewing appeals for appropriateness, documenting the claim specifics into the current software and routing documentation to business partners for review/resolution.
ESSENTIAL FUNCTIONS:
- Independently review and analyze appeals related to Allied's Cost Containment programs.
- Review Summary Plan Documents to determine validity of appeals.
- Review, analyze and add applicable notes to the QicLink System
- Review/audit processed health care claims for accuracy.
- Consult with other entities who can offer additional review of an appeal.
- Respond timely and appropriately to inquiries related to the No Surprises Act, including Independent Dispute Resolution (IDR) and open negotiation requests.
- Other duties as assigned.
EDUCATION
- High School Diploma, College and Advanced Degrees Preferred
EXPERIENCE & SKILLS
- Knowledge of International Classification of Diseases (ICD) and/or Current Procedural Terminology (CPT) codes required.
- Intermediate level work experience with Microsoft Office, Word, Excel, and Power Point applications.
- Ability to multi-task, this includes ability to understand multiple products, multiple levels of benefits within each product and work within multiple systems.
- Excellent verbal and written communication skills.
- Strong analytical and critical thinking skills.
- Excellent organizational skills and mindfulness.
- Excellent time management skills with a proven ability to meet deadlines.
- 2-4 years' experience analyzing healthcare claims (processing claims)
COMPETENCIES
- Job Knowledge
- Time Management
- Accountability
- Communication
- Initiative
- Customer Focus
PHYSICAL DEMANDS
- Ability to sit for extended periods of time. Ability to communicate via telephone.
WORK ENVIRONMENT
- Remote
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
High School or Equivalent
Required Experience
2 to 4 years
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