Provider Payment Appeals Analyst I

🔥 15 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $22 - $34 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Support the Payment Dispute process across all lines of business • Resolve Provider Payment Appeal requests • Review and analyze provider requests to investigate dispute outcomes • Determine whether to uphold or overturn primary decisions based on all available information • Work with Provider Solutions and Health Plan Operations leadership to determine root causes and appropriate resolutions • Review and reprocess claims to provide appropriate solutions

🎯 Requirements

• High school diploma or GED • Minimum 3 years of claims research and/or issue resolution or reimbursement methodology analysis within the healthcare industry • Education and experience combination providing an equivalent background may be considered • Experience with NextGen, GBD Facets, and CCERT is highly preferred • Ability to work Monday–Friday, 8-hour shifts during EST • Ability to review and reprocess claims • Ability to work virtually full-time and attend required in-person training • Must be within a reasonable commuting distance from the posting location unless an accommodation is granted

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401(k) contribution and match • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short- and long-term disability benefits • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Flexible start time between 6:00 am and 9:30 am EST • Required in-person training sessions with virtual full-time work otherwise