Appeals Analyst

Xsolis, Inc

About The Position

The Appeals Analyst works with clients and client representatives to investigate denied claims, document investigations, and pursue reimbursement for denied services. The role requires a strong understanding of clinical policies, contracts, and regulations to guide research into claim denials, as well as the ability to build relationships with clients, payers, and providers and draft persuasive reimbursement arguments. The position is typically performed in a normal office administrative environment with minimal exposure to physical risks. It involves little to moderate physical activity and is mostly sedentary, with sitting most of the time and occasional walking or standing. The role requires travel to the company’s home offices in Tennessee for training. The position is full-time. Full-time employees receive a total rewards package that includes medical, dental, and vision insurance; a 401(k) company match; flexible paid time off; paid parental leave; HSA/FSA options; educational reimbursement; and employer-paid EAP and mental health services. Candidates must pass a background check and be authorized to work in the United States without current or future visa sponsorship.

Requirements

High school diploma required.
2–4 years of experience in appeals and claim processing.
Verbal and written communication skills.
Customer service skills.
Analytical skills.
Proficiency with the MS Office Suite.
Negotiation, problem recognition, and resolution skills.
Ability to multitask.

Nice To Haves

Associate’s degree or higher.

Responsibilities

Resolve claims by reviewing supporting documentation, calculating benefits due, initiating payment or composing appeal letters, guiding resolution of non-routine claims, and auditing claims for appropriate payment.
Navigate multiple facility patient accounting systems.
Prepare reports by gathering analytical information and developing it into a finished product.
Analyze claims to determine the validity of denials and recovery options.
Draft detailed and convincing correspondence to effect reimbursement.
Develop relationships with insurance carriers, patients, attorneys, and employers to facilitate reimbursement.
Conduct research as necessary to build a strong reimbursement argument.
Research and review clinical policies, contracts, and other materials to support claims recovery.
Work independently and as part of a team to identify trends in client inventories and formulate recovery resolutions.
Clearly and concisely document actions through resolution in a claims recovery system.
Ensure legal compliance by following guidelines, contracts, regulations, and the company’s business plan.
Maintain quality service by following corporate provider and payer service practices and protocols.