Provider Services Analyst I - Remote

Overview

The Provider Services Analyst I is responsible for analyzing claims denials and crafting appeal letters to resolve issues with insurance payers, contributing to improved healthcare access.

In Short

• Analyze remittance and explanation of benefits for denials.
• Craft detailed appeal letters for reimbursement.
• Contact insurance carriers and other stakeholders for resolution.
• Maintain quality service by following corporate protocols.
• Interpret contracts related to reimbursement guidelines.
• Document all actions taken in the claims recovery system.
• Identify root causes and trends in client inventories.
• Utilize payer portals and technologies to expedite revenue.
• Work independently and within a team structure.
• Stay updated on healthcare industry policies and regulations.

Requirements

• Experience in processing and recovering clinical/technical denials.
• Knowledge of UB04s and Claim Adjustment Reason Codes preferred.
• Ability to compose compelling appeal letters.
• Experience with EMRs like Cerner or Epic.
• Strong customer service and analytical skills.
• High School Diploma with some college education.
• Experience in the healthcare market.
• Familiarity with Microsoft Office products.
• Detail-oriented and able to multi-task effectively.
• Understanding of medical terminology is preferable.

Benefits

• Competitive salary.
• Health insurance.
• 401(k) plan with employer match.
• Paid parental leave.
• Collaborative and innovative work environment.