Mindlance · 9 hours ago
Appeals Analyst
United States
Full-time
Remote
Mid Level
3+ years expMindlance is a company focused on providing solutions in the healthcare sector, and they are seeking an Appeals Analyst to manage and resolve appeals, coding disputes, and grievances. The role involves analyzing health plan benefits and ensuring compliance with regulatory guidelines while providing comprehensive responses to various stakeholders.
Human Resources
Responsibilities
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 and regulatory 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 Client NC policies and guidelines. Acts decisively to ensure business continuity and with awareness of all possible implications and impact
Prepare files and develops Client NC 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 BCBSNC policies and procedures (to include BCBSA requirements)
Qualification
Required
Bachelor's degree or advanced degree where required
3 years of related experience
In lieu of degree, 5 years of related experience
For coding disputes area, certified professional coder must be obtained within 1 year of employment
Company
Mindlance
Mindlance is a Staffing and Recruiting company which provides multi-vertical staffing services
1001-5000 employees
H1B Sponsorship
Mindlance has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (71)
2024 (53)
2023 (37)
2022 (72)
2021 (36)
2020 (40)
Funding
Current Stage
Late StageLeadership Team
R
Rajat Paul Dhall
Co-Founder & Managing Director
V
Vik Kalra
Co-Founder and Managing Director
Recent News
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