Senior Grievance and Appeals Analyst | Remote
WalkerHealthcareIT is seeking a Senior Grievance and Appeals Analyst for a healthcare client located in Michigan. This is a remote contract opportunity.

START DATE: ASAP

ON-SITE / REMOTE: Remote

WAGE TYPE: 1099, W2

WalkerHealthcareIT Standard Perks

• Weekly pay via Direct Deposit

Senior Grievance and Appeals Analyst - Job Description
Responsible for the analysis, research, and completion of complex non-contracted provider Medicare appeal investigations. Effectively administer all steps of the non-contracted provider appeal to thoroughly investigate appeal requests, leveraging critical thinking skills, gathering relevant information from enterprise-wide systems, and collaboration to resolve issues whenever possible. Ensure compliance with all mandated, legislative, regulatory and accreditation requirements. Assist customers and staff throughout the process by providing complete information and follow up on a timely basis.

The Appeals Analyst makes decisions on moderately complex issues regarding technical approach for project components, and work is performed without direction. Exercises latitude in determining objectives and approaches to assignments.

Senior Grievance and Appeals Analyst Mandatory Job Requirements

• 5 years of relevant experience Grievance & or Appeal Analyst or related experience Required
• 3 years of relevant experience Member or Provider Customer service, Claims, Legal and/or enrollment/eligibility Preferred
• Extensive knowledge of managed care products and regulatory and accreditation requirements

Senior Grievance and Appeals Analyst Job Requirements

• Responsible for complex and thorough investigation of Medicare appeals from a non-contracted provider which may include: gather all relevant information for the appeal request (external medical records, internal documentation from enterprise-wide systems including: claims payments, billing and enrollment, care management, medical, pharmacy and behavioral health authorizations, customer service interactions, prescription claims, medical policies, and plan documents)
• Resolve appeal timely per CMS guidelines; when appropriate, including collaboration internally with all levels within the organization
• Analyze and investigate requests for submission to the Independent Review Entity ( IRE) which may include: gathering relevant information and prepare comprehensive documentation as “evidence”. Ensure timely submission of documentation.
• Track all activity including communication for each appeal case by entering complete documentation of issues and related follow-up
• 5 years of relevant experience Grievance & or Appeal Analyst or related experience Required
• 3 years of relevant experience Member or Provider Customer service, Claims, Legal and/or enrollment/eligibility Preferred
• Extensive knowledge of managed care products and regulatory and accreditation requirements;
• Maintain knowledge of policies and procedures, including medical policies which may impact the grievance, appeal and review processes Preferred

ABOUT US
WalkerHealthcareIT is a certified MBE and WBE uniquely focused on supporting clients within the healthcare industry by placing qualified people in healthcare IT, clinical healthcare, and professional roles. As an experienced and reputable firm in consulting services, we have 15 years of proven experience in supporting healthcare systems and payers including Fortune 100 companies.

#IND3
#IND1