Managed Care Appeals Analyst

Elevate Patient Financial Solutions is seeking a Managed Care Appeals Analyst to work remotely full-time (8 AM-5 PM, Monday-Friday).

The role involves researching closed $0 balance accounts to identify underpayments by payors based on contracts, creating 1st and 2nd level appeals for under-reimbursed accounts, and ensuring payments comply with contractual agreements. Duties include conducting systematic account reviews, posting adjustments, using contract and audit notes to troubleshoot reimbursement, creating detailed appeals citing contract details, verifying eligibility, coordination of benefits, and claim status using payor portals, monitoring payments and resolving outstanding balances, and documenting outcomes per procedures.

You will communicate professionally with coworkers, clinical staff, coders, supervisors, and payor representatives and stay compliant with HIPAA and organizational policies. Cross training in multiple hospital systems is expected.

Qualifications include an Associate or Bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration or related field, or 4 additional years of relevant experience. At least one year of healthcare auditing experience is required, plus 4+ years experience in revenue cycle, hospital reimbursement, third party contracting, and appeals writing. Knowledge in reimbursement methodologies (DRG, EAPG, OPPS, APC), claims data analysis, medical billing terms, Microsoft applications, and HIT systems (EPIC, Cerner, etc.) is necessary. Ability to write formal business communications and access reliable home internet for remote work are required.

Benefits include medical, dental, vision insurance, 401K with company match, paid time off and holidays, pet insurance, employee referral bonuses, teamwork culture, and career growth opportunities.

Salary is hourly ($24 - $30/hour) and will be set based on factors like experience, education, location, and specialty.

Elevate Patient Financial Solutions is an Equal Opportunity Employer committed to continuous improvement and delivering superior revenue cycle management services nationwide.