Demo

Appeals Analyst

Motion Recruitment
Durham, NC Contractor
POSTED ON 1/7/2025 CLOSED ON 2/6/2025

What are the responsibilities and job description for the Appeals Analyst position at Motion Recruitment?

Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract to hire opening for an Appeals Analyst. They have over 4 million customers and 5,000 employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs.

Location: ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

Required Skills & Experience

  • Bachelor’s degree or advanced degree where required. In lieu of degree, 5 years of related experience
  • 3 years of related experience
  • Certified Professional Coder (CPC) required

What You Will Be Doing

  • Analyze, research, resolve and respond to confidential/sensitive appeals, grievances and coverage/organization determinations from members, member's representatives, providers, media outlets, senior leadership and regulatory agencies with established regulatory and accreditation guidelines.
  • Analyze, interpret, and explain health plan benefits, policies, procedures, medical terminology, coding and functions to members and/or providers.
  • Regularly and independently exercise judgement to make appropriate decisions based on policies and guidelines. Acts decisively to ensure business continuity and with awareness of all possible implications and impact.
  • Prepare files and develops position statements for external reviews performed by independent review organizations, benefit panels and external medical consultants.
  • Provide comprehensive appeals and grievances responses that support the decision and comply with regulatory and accreditation guidelines.
  • Document extensive investigation, relative findings, and actions in all applicable systems
  • Accountable for monitoring daily reports to ensure service timeliness and compliance is met.
  • Gather clinical information by using established criteria provided in corporate medical policies; partner with Medical Directors who are responsible for all decisions regarding clinical appeals/grievances.
  • Ensures timeliness, quality, and efficiency in all work to comply with applicable mandated State (NCDOI) and/or Federal (Centers for Medicare & Medicaid Services (CMS), ERISA, etc.) accreditation agency standards (National Committee for Quality Assurance – NCQA), ASO group performance guarantees and policies and procedures (to include requirements).
  • To be eligible to contract at this client you must be able to pass a drug test and criminal background check Posted By: Andrew Chadwick
Registered Nurse (RN) - Clinical Denials & Appeals
ECU Health -
Greenville, NC
Supervisor of Clinical Denials & Appeals - Central Business Office Management
ECU Health -
Greenville, NC
Analyst
InsideHigherEd -
Chapel Hill, NC

If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

What is the career path for a Appeals Analyst?

Sign up to receive alerts about other jobs on the Appeals Analyst career path by checking the boxes next to the positions that interest you.
Income Estimation: 
$48,731 - $60,363
Income Estimation: 
$55,490 - $70,607
Income Estimation: 
$49,313 - $64,855
Income Estimation: 
$49,126 - $60,591
Income Estimation: 
$38,612 - $46,691
Income Estimation: 
$48,731 - $60,363
Income Estimation: 
$43,963 - $55,591
Income Estimation: 
$44,557 - $53,909
Income Estimation: 
$49,126 - $60,591
Income Estimation: 
$70,647 - $86,374
Income Estimation: 
$123,613 - $165,638
Income Estimation: 
$69,116 - $84,792
Income Estimation: 
$87,788 - $104,837
Income Estimation: 
$70,647 - $86,374
Income Estimation: 
$123,613 - $165,638
Income Estimation: 
$69,116 - $84,792
Income Estimation: 
$44,557 - $53,909
Income Estimation: 
$55,490 - $70,607
Income Estimation: 
$49,313 - $64,855
Income Estimation: 
$49,126 - $60,591
This job has expired.
View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

Job openings at Motion Recruitment

Motion Recruitment
Hired Organization Address Charlotte, NC Full Time
Outstanding long-term contract opportunity! A well-known Financial Services Company is looking for a Technical Program M...
Motion Recruitment
Hired Organization Address Orlando, FL Contractor
Our client, a well known theme park and hospitality company is urgently looking to hire an Electrical Designer to join t...
Motion Recruitment
Hired Organization Address Minneapolis, MN Full Time
Description : 5 to 7 years of experience in Information Technology with expertise in test automation of applications fro...
Motion Recruitment
Hired Organization Address Minneapolis, MN Contractor
Our client, a major airline, is actively looking for a System Engineer to join their team in Minneapolis, MN! This role ...

Not the job you're looking for? Here are some other Appeals Analyst jobs in the Durham, NC area that may be a better fit.

STD Appeals Manager

Lensa, Raleigh, NC

Nurse Appeals Associate

Lensa, Durham, NC

AI Assistant is available now!

Feel free to start your new journey!