Provider Payment Appeals Analyst I

$50,606 - $75,920/Yr

Elevance Health - Denver, CO

Full-time

Denver, CO

Insurance Carriers and Related Activities

About the position

The Provider Payment Appeals Analyst I plays a crucial role in supporting the Payment Dispute process across various lines of business. This position is primarily responsible for resolving Provider Payment Appeal requests by reviewing and analyzing provider requests, determining the outcome of Reconsiderations, and collaborating with multiple departments to ensure appropriate resolutions are achieved.

Responsibilities

• Review and analyze provider requests to investigate the outcome of a Reconsideration.
• Determine whether to uphold or overturn primary decisions based on all available information.
• Collaborate with Provider Solutions and Health Plan Operations leadership to identify root causes and appropriate resolutions.
• Work with Claims Operations to remediate impacted claims.

Requirements

• High School diploma or GED required.
• Minimum of 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry.

Nice-to-haves

• Bachelor's degree preferred.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution