Appeals Resolution Associate

Building Location:Business Service Center

Department:46110 Payment Integrity

Job Description:The Appeals Resolution Specialist is responsible for conducting the research needed to evaluate, process, and create appeals, and respond to payer disputes and reconsiderations to ensure a timely decision. This position works closely with the Contract Management Analysts to present data on appeal trends and final resolutions. In collaboration with Payment Integrity Manager, this position will aid in the research and trending of payer payment issues and provide root cause analysis as to the issues.

Education Qualifications:

Key Responsibilities:

• Initiate level 1 appeals with payers
• Review response from payers on level 1 appeals and initiate level 2 appeals if necessary
• Submit appeals and reconsiderations on claim rejections, underpayments and denials
• Initiates insurance follow up on unresolved claims
• Identify, track, and report payer appeal/denial trends to management
• Refers appeal cases to the designated department for obtaining support for appeals

Educational Requirements:

• Associate’s degree in accounting, business or related medical field

Required Qualifications:

• 1-3 years experience in revenue cycle operations

Preferred Qualifications:

• Previous experience in medical appeals submissions
• Knowledge of EOB’s, EFT payments, claims submission, denials, and ANSI codes
• Understand Medicare and Medicaid rates
• High attention to detail, be able to multitask, and prioritize tasks
• Must be proficient in MS office and Excel
• The ability to work independently and as part of a team
• Excellent written and verbal communication skills

Licensure/Certification Qualifications:

FTE:1

Possible Remote/Hybrid Option:

Remote

Shift Rotation:Day Rotation (United States of America)

Shift Start Time:8:00

Shift End Time:5:00

Weekends:

Holidays:No

Call Obligation:No

Union:DC USWA Main & Neighborhoods (DCUMN)

Union Posting Deadline:01/8/2025

Compensation Range:

$19.04 - $28.37

Employee Benefits at Essentia Health*:

• Health Coverage: Medical, dental, vision, life and disability insurance, plus supplemental health benefit options to ensure employees' well-being.

• Retirement Savings Plans: 401(k) with employer contributions to support long-term financial security.

• Professional Development: Opportunities for career growth through training, tuition reimbursement, and educational programs.

• Work-Life Balance: Flexible scheduling, time off, holidays, and personal leave to help employees manage their professional and personal lives.

• Employee Wellness Programs: Initiatives focused on physical, mental, and emotional health, including fitness memberships, counseling services, and wellness activities.

*Eligibility for Essentia Health’s benefit programs vary. Please refer to the benefit summary provided to you, or contact our HR Service Center at (218) 576-0000 for more information.