Appeals Analyst

Job Description

Immediate need for a talented Appeals Analyst. This is a 06+months contract opportunity with long-term potential and is located in Durham,NC(Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-32226

Pay Range: $25 - $28/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

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• Analyze and respond to appeals, coding disputes, and grievances from members, providers, and regulatory agencies.
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• Interpret and explain health plan benefits, policies, and medical terminology to stakeholders.
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• Prepare position statements for external reviews and document investigations thoroughly.
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• Collaborate with Medical Directors to gather clinical information for appeals and grievances.
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• Ensure compliance with state and federal accreditation standards and organizational policies.
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• Monitor daily reports to maintain service timeliness and compliance.
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Key Requirements and Technology Experience:

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• 3+ years of related experience; in lieu of a degree, 5+ years of related experience.
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• Bachelor’s degree or advanced degree where required.
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• For coding disputes, a certified professional coder must be obtained within 1 year of employment.
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Our client is a leading Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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