Expired job

Just missed a job?

Sign up and never miss an opportunity again!

Medical Appeals Analyst job

Healthcare Financial Resources, LLC jobs

Company

Skills

Job Description

Essential Duties:


Review requests from Operations/Financial Analyst and review medical records to determine validity of request and approve and document medical necessity in proprietary system.

Generate Medical Appeals including, but not limited to, medical necessity, non-emergent, experimental and retro authorization.

Ensure that the requests for Medical Records from Operations/Financial Analyst are maintained within 7 business days.

Track, file, and communicate trends.

Maintain and log established information from incoming requests for appeals on the Medical Records log.

Properly file/store away the documents for pending written appeals.

Conduct general appeal research and filing as needed.

Maintains all documentation associated with the processing and handling of appeals to comply with regulatory standards and timeframes.

Meet appeal filing deadlines by completing assigned work tasks in a timely matter.

Keep all patient health information (HIPAA) and other proprietary information confidential.

Communicate with diplomacy and professionalism with all levels of employees in the organization.

Must apply knowledge of billing terms, denials, and documents to determine how best to resolve customer service issues.

Must notify upper management upon learning of any unauthorized disclosure or inappropriate use of confidential information (HIPAA).

Return packets to the supervisors when additional appeal information is needed.

Send emails to the appropriate personnel when timely filing is becoming an issue.

Properly document in proprietary system.

The employer reserves the right to assign other duties.


Requirements:

Knowledge of carrier clinical policy bulletins.

Educational background or professional experience working with claim processing, third party reimbursement, and / or contractual issues.

Knowledge of how to operate basic computer functions.

Proficiency in MS Office applications (Excel, Word & Outlook) is required.

Proficiency in reading, writing and arithmetic in order to investigate claims issues, appeal denied claims, and understand how to apply contract rates.

Must demonstrate strong verbal and written communication skills.

Must have strong analytical and troubleshooting skills.

Must be a team member.

Ability to handle multiple tasks at once.

Ability to work efficiently, in an organized fashion, and meet daily and monthly department performance goals.

Must possess good customer service skills.


Education/Experience:

College Degree or in process of obtaining a degree through the course of employment.

Certified Registered Nurse (RN) or minimum of 2 years of relevant studies as a Registered Nurse (RN) and professional experience working with claim processing, third party reimbursement and / or contractual issues.

TASKS

  • Protect the security of medical records to ensure that confidentiality is maintained.
  • Review records for completeness, accuracy, and compliance with regulations.
  • Retrieve patient medical records for physicians, technicians, or other medical personnel.
  • Assign the patient to diagnosis-related groups (DRGs), using appropriate computer software.

SKILLS

  • Reading ComprehensionUnderstanding written sentences and paragraphs in work related documents.

KNOWLEDGE

  • ClericalKnowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
  • Computers and ElectronicsKnowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
  • English LanguageKnowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

Healthcare Financial Resources, LLC

Type

Company - Private

Revenue

$1M to $5M

Location

Chicago, IL, and others

Industry

Healthcare

Closed Job Filters

Claims AnalystHealthcare Financial Resources, LLCElgin, IL
PURPOSE The purpose of an HFRI Claims Representative is to analyze, investigate and resolve unpaid claims for our clients. They do this through extensive verbal and written contact with InsuranceRead more
Medical Appeals AnalystHealthcare Financial Resources, LLCChicago, IL
Essential Duties: Review requests from Operations/Financial Analyst and review medical records to determine validity of request and approve and document medical necessity in proprietary system.Read more
Medical Appeals AnalystHealthcare Financial Resources, LLCCook County, IL
Essential Duties: · Review requests from Operations/Financial Analyst and review medical records to determine validity of request and approve and document medical necessity in proprietary system.·Read more
Claims Analyst.Healthcare Financial Resources, LLCChicago, IL
PURPOSE. The purpose of an HFRI Claims Analyst is to analyze, investigate and resolve unpaid claims for our clients.They do this through extensive verbal and written contact with Insurance carriers.Read more
Claims AnalystHealthcare Financial Resources, LLCCook County, IL
PURPOSE The purpose of an HFRI Claims Analyst is to analyze, investigate and resolve unpaid claims for our clients. They do this through extensive verbal and written contact with Insurance carriers.Read more
Similar jobs in the area
One of the largest health insurers in the nation is focused oncontinuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your...Read more
A healthcare technology company is in need of a Remote Medical Economics Senior Analyst. Core Responsibilities of this position include: Performing analysis of complex and varied healthcare data Being responsible for financial modeling, reserving and risk...Read more
The Group: The Investment Management group is a global team guided by Morningstar's investment principles focused on delivering great long-term investment results to help end-investors reach their financial goals. Morningstar® Managed PortfoliosSM, our...Read more
This person has significant experience in the health payer industry, especially with the Blues. Knowledgeable of best practices and understands industry trends and challenges. Seeking an experienced senior healthcare business analyst with diversified...Read more
gig jobs
Deliver with Uber. Earn on your schedule. Sign up to deliver with Uber Eats and earn $1200 when you complete 100 deliveries in your first 90 days. Work on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends; it's up to...Read more
Seeking an experienced Senior Healthcare Business Analyst with diversified experience in areas such as project and product management in healthcare and insurance applications. Requirements: Experience with and deep knowledge of eliciting and facilitation...Read more
gig jobs
College Accounting Tutor JobsVarsity TutorsChicago, IL
Online Remote College Accounting Tutor Varsity Tutors is looking for an expert like you to tutor College Accounting online! By partnering with Varsity Tutors, tutoring online is not only comparable to in person - it's better: Conduct sessions face-to-face...Read more
Business Analyst- HealthcareBains Consulting LLCChicago, IL
Experienced business analyst with diversified experience in areas such as project and product management in healthcare and insurance applications. Have a background including deep knowledge of eliciting and facilitation of business requirements, creating...Read more
A provider of outsourced medical coding services is in need of a Remote Cardiology Charge Analysts. Core Responsibilities of this position include: Accurately and timely posting of Cath Lab and EP Lab charges Providing compliant charging practices for all...Read more
A media and marketing solutions company is searching for a person to fill their position for a Telecommute Performance Analyst. Must be able to: Track and evaluate account performance Provide measured recommendations for campaign optimization...Read more
About the roleThe Customer Care Analyst role will entail multiple facets of operations including CRM system enhancements, data analysis, and reporting. Other responsibilities include: Creating, managing, and disbursing reports related to the other...Read more
Location Chicago, IL Duration: 6 months Responsibilities Epic Cadence/Welcome Analyst neededRead more
Show more jobs
500+ more jobs

Similar jobs

Overview At Perficient you’ll deliver mission-critical technology and business solutions to Fortune 500 companies and some of the most recognized brands on the planet. And you’ll do it with cutting-edge technologies, thanks to our close partnerships with...Read more
Diversity and inclusion matters at Advocate Aurora Health. We celebrate our differences and nurture an environment where everyone feels included. We know that when we reflect the communities we serve, when we embrace differences and bring our whole selves...Read more
The CSA contributes to service delivery, business retention and revenue growth objectives of the sales account team, through selling and support efforts. The CSA is an important resource within Frontier that provides the customer with easy access and...Read more
Overview Supports information management needs of various client departments or workflows across the organization through project coordination, applications implementation, upgrades, and ongoing maintenance or enhancements. Manages small and medium sized...Read more
What We'll Bring: At TransUnion, we have a welcoming and energetic environment that encourages collaboration and innovation. We are consistently exploring new technologies and tools to be agile. This environment gives our people the opportunity to hone...Read more
As a successful Workforce Management Real Time Analyst you are responsible for the intraday management and tactical planning of sales and service contact center queues to ensure staffing and opportunities are properly aligned. Areas of focus will include...Read more
Supports information management needs of various client departments or workflows across the organization through project coordination, applications implementation, upgrades, and ongoing maintenance or enhancements. Manages small and medium sized projects...Read more
Epic Inpatient Clin Doc AnalystblueStone Staffing SolutionsChicago, IL
Our Client is rated as one of the top children’s hospitals in the country. They are looking to add an Epic ClinDoc Analyst to their team on a direct placement basis. This opportunity, based out of Chicago, offers a very competitive compensation and...Read more
A staffing agency is in need of a Remote Data Analyst. Must be able to: Review, interpret and analyze both clinical and operational data from various sources Analyze healthcare utilization, operational and financial data Design and develop reports that...Read more
A financial institution needs applicants for an opening for a Remote Performance Metrics Analyst. Core Responsibilities of this position include: Utilizing systems and data to resolve business issues Developing recommendations to solve problems and issues...Read more