Appeal Analyst

🕒 September 29

🥔 Idaho, North Dakota, +4 more states – Remote

🥔 Idaho – Remote 🌾 North Dakota – Remote 🌲 Oregon – Remote ❄️ Minnesota – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $41.1k - $53.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 30%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 46 days.
• Jobs at this company usually fill in 21 days.
• Reposted once.

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1948

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Arkansas Blue Cross and Blue Shield is a health insurance provider licensed to offer health plans in all 75 counties of Arkansas. The company offers a wide range of insurance products including individual and family plans, Medicare and Medigap plans, dental and vision plans, as well as health plans for travelers and employer group plans. They provide members with personalized services such as health management through the Blueprint Portal, where users can manage their health plan, review claims, find healthcare providers, and estimate treatment costs. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

📋 Description

• Analyze and respond to inquiries, complaints and/or concerns from members, providers, regulatory bodies and/or attorneys • Communicate medical coverage policy, processing guidelines and policy language with internal and external sources to facilitate, resolve, and respond to appeals within URAC/legal timeframe • Maintain administrative records of all case files, log the appeal for each inquiry, and request relevant information from appropriate internal and external sources • Maintain thorough knowledge of the benefit plans • Monitor the status of appeals • Prepare written analysis communicating facts and determinations for appeal responses within the timeframe • Recommend changes to the appeals process and contract language, as necessary, to minimize legal and regulatory liability • Utilize current information from medical coding sources to ensure guidelines used in appeals are clear and concise • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree in related field, or five (5) years' relevant experience in lieu of degree in addition to the experience requirements listed below • Minimum three (3) years' healthcare grievances, appeals, claims processing, claims research, customer service or related legal experience • Working knowledge of insurance products, policies, procedures and/or claims processing preferred • Experience using Microsoft Office, including Word and Excel • Sound Judgement • HIPAA Confidentiality • Legal Confidentiality • Taking Initiative • Work from home within Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, or Minnesota

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