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MedStar Health · 1 month ago

Health Benefits Appeals Analyst

Columbia, MD

Full-time

Onsite

Senior Level

$28.76/hr - $48.96/hr

5+ years exp

MedStar Health is a healthcare organization seeking a Health Benefits Appeals Analyst. The role involves researching and resolving health plan appeals, communicating with providers, and maintaining accurate records while ensuring compliance with state regulations.

Health CareMedical

Responsibilities

Researches and analyzes health plan benefits fee schedules and payment policies to determine how to decision provider requests

Reviews claims appeals provides communication to providers keeps accurate and complete claims appeal records. Researches and resolves billing and payment issues

Assists in implementing and maintaining administrative claims appeal policies procedures and appeal infrastructure

Coordinates the review and processing of provider claim appeals. Evaluates and investigates claim appeals by reviewing plan benefit documentation payment and reimbursement policies

Generates appeal acknowledgment letters and resolution letters per Maryland Department of Health (MDH) / District of Columbia regulations

Ensures that providers have submitted appeal request timely

Tracks all inquiries or complaints to ensure that cases are resolved within State-required timeframes. Documents resolution and prepares and sends written correspondence in response to members initiating complaints within State / NCQA required timeframes

Maintains established daily performance benchmarks and meets the established productivity standard for the department

Qualification

Claims processingManaged care experienceHealthcare administrationData miningAnalytical skillsCertified Professional CoderClaims Appeals certificationMicroSoft ExcelMicroSoft AccessVerbal communicationWritten communicationProblem-solving

Required

Associate degree in Healthcare Administration, Business Administration or related field

5-7 years Experience in the health care delivery system or insurance setting

Experience with managed care/claims appeals experience including experience with insurance/managed care benefits and procedures for appeals and claims processing

Knowledge of all aspects of claims processing auditing coding A/R and reporting (MicroSoft Excel and Access)

Excellent verbal and written communication skills

Data mining and analytical skills

Ability to recognize analyze and solve a variety of problems