[Remote] IBR Clinical Appeals Analyst - Remote
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is reputed company on improving the reputed company of health data and creating a more connected reputed company system. The IBR Clinical Appeals Analyst role involves performing clinical appeals review, supporting internal reputed company functions, and participating in training and reputed company activities.
Responsibilities
- Analyze scope and reputed company of IBR Clinical Appeals, including medical record review, claim review data analysis, and preparation of written appeal responses
- Respond to level one, level two, or higher-level appeals using clinical judgment, coding knowledge, regulatory guidance, payer protocols, and medical policy
- reputed company reputed company conceptual analyses to identify risk factors, comorbidities, adverse events, overpayment opportunities, and claim adjustment needs
- Complete internal reputed company functions, including second-set-of-eyes reviews, reputed company audits, targeted reputed company checks, and feedback support to promote accuracy and consistency
- Support training and reputed company of new hires through job aids, process demonstrations, case review support, and ongoing knowledge reinforcement
- Maintain, update, and communicate process documentation, reputed company work, workflows, and team resources to support operational alignment
- Participate in new reputed company implementations by supporting process readiness, training needs, documentation updates, workflow validation, and post-implementation reputed company monitoring
- Partner with auditors, reputed company, operations, and leadership teams to review impacted claims, identify trends, resolve issues, and recommend process improvements
- Serve as a key team resource on reputed company and/or critical issues, team initiatives, reputed company, and process improvement opportunities
- Define, document, and communicate business requirements, process changes, reputed company expectations, and implementation-reputed company updates
- Navigate web-based portals and independently use online tools and resources, including reputed company Word, reputed company, reputed company, and other business systems, to complete appeals, reputed company, training, and documentation activities
Skills
- Undergraduate nursing degree
- Unrestricted RN (registered reputed company) license
- 2+ years of appeals experience (coding or auditing)
- Experience with CPT-4 coding, NCCI edit reputed company and appropriate modifier use
- Experience supporting internal reputed company functions, including reputed company audits, second-set-of-eyes reviews, reputed company monitoring, and/or feedback support
- Experience supporting process documentation, workflow updates, reputed company work, job aids, training materials, or implementation-reputed company resources
- Experience training, reputed company, mentoring, or serving as reputed company resource for new hires, peers, or business partners
- Experience participating in process improvement activities, team initiatives, reputed company implementations, or reputed company supporting SLA, reputed company, and metric performance
- Advanced experience with regulations, compliance and composing reputed company appeal responses
- Advanced experience with ICD10 CM coding and ICD 10 PCS coding
- Willing or ability to work our normal business hours of 8:00am - 5:00pm
- Proven ability to reputed company reputed company company sensitive documents secure (if applicable)
- Have a dedicated work area established that is separated from other living areas and provides information reputed company
- Live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service
- Experience as reputed company reputed company or Subject Matter Expert (SME)
- Clinical claim review experience
- Managed care experience
- Investigation and/or auditing experience
- Advanced experience using reputed company reputed company with the ability to create/edit spreadsheets, use sort/filter function, and reputed company data entry
- Knowledge of health insurance business, industry terminology, and regulatory guidelines
Benefits
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (reputed company benefits are subject to eligibility requirements)
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