Appeals Analyst Durham, North Carolina **100% Remote** Contract $20/hr - $25/hr Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Appeals Analyst. They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs. **Location:** ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming. Contract Duration: 12 Months, Contract to Hire **Required Skills & Experience** + Bachelor’s degree or advanced degree where required. + 3 years of related experience + In lieu of degree, 5 years of related experience + Must be CPC Certified **Desired Skills & Experience** + Care Radius a plus + Facets a plus **What You Will Be Doing** + Analyze, research, resolve and respond to confidential/sensitive appeals, coding disputes, grievances and coverage/organization determinations from members, member's representatives, providers, media outlets, senior leadership andregulatory agencies with established regulatory and accreditation guidelines. + Analyze, interpret, and explain health plan benefits, policies, procedures, medical terminology, coding and functions to members and/or providers. + Regularly and independently exercise judgement to make appropriate decisions based on clients policies and guidelines. Acts decisively to ensure business continuity and with awareness of all possible implications and impact. + Prepare files and develops clients position statements for external reviews performed by independent review organizations, benefit panels and external medical consultants. + Provide comprehensive appeals, coding disputes and grievances responses that support the decision and comply with regulatory and accreditation guidelines. + Document extensive investigation, relative findings, and actions in all applicable systems + Accountable for monitoring daily reports to ensure service timeliness and compliance is met. + Gather clinical information by using established criteria provided in corporate medical policies; partner with Medical Directors who are responsible for all decisions regarding clinical appeals/grievances. + Ensures timeliness, quality, and efficiency in all work to comply with applicable mandated State (NCDOI) and/or Federal (Centers for Medicare & Medicaid Services (CMS), ERISA, etc.) accreditation agency standards (National Committee for Quality Assurance – NCQA), ASO group performance guarantees and policies and procedures (to include clients requirements). ******To be eligible to contract at this client you must be able to pass a drug test and criminal background check** **You will receive the following benefits:** + Medical Insurance - Four medical plans to choose from for you and your family + Dental & Orthodontia Benefits + Vision Benefits + Health Savings Account (HSA) + Health and Dependent Care Flexible Spending Accounts + Voluntary Life Insurance, Long-Term & Short-Term Disability Insurance + Hospital Indemnity Insurance + 401(k) including match with pre and post-tax options + Paid Sick Time Leave + Legal and Identity Protection Plans + Pre-tax Commuter Benefit + 529 College Saver Plan Motion Recruitment Partners (MRP) is an Equal Opportunity Employer. All applicants must be currently authorized to work on a full-time basis in the country for which they are applying, and no sponsorship is currently available. Employment is subject to the successful completion of a pre-employment screening. Accommodation will be provided in all parts of the hiring process as required under MRP’s Employment Accommodation policy. Applicants need to make their needs known in advance. **Posted by:** Andrew Chadwick **Specialization:** + Medical / Healthcare Professional