[Remote] Appeals Analyst at Expedia

Heredia, Heredia Province, Costa Rica

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Not SpecifiedCompensation

Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Financial Services, InsuranceIndustries

Requirements

Bachelor's degree in related field, or equivalent education and experience
Minimum of two years experience working with managed care claims and appeals for health care professional services (physicians and other health care professionals)
Experience working with a Contract Manager application
Experience in a production environment is desirable but comfort in such an environment is essential
Experience with digital & remote office equipment
Knowledge of the health care professional services billing (physicians and related health care professionals) and reimbursement environment
Knowledge of major types of practice management system (PMS) and EOB imaging systems, with experience working with at least one industry leading PMS
Knowledge of medical terminology
Knowledge of networks, IPAs, MSOs, HMOs, PCP and contract affiliations
Knowledge of managed care contracts and compliance

Responsibilities

Monitors contractual allowances, analyzes and pursues appeal opportunities with payers and networks, and reports appeals performance
Implements process for identifying under-allowed claims using Contract Manager Product and other available tools
Reviews and analyzes EOBs for identified under-allowed claims
Verifies applicable contract by reviewing EOB messages, patient ID card, verifying member information for managed care plans
Batches appeals by payer or network, by CPT/HCPCS code combination, by error type, or by provider
Compiles and submits appeals, and monitors for proper reimbursement
Uses Contract Manager application to track appeals and appeal outcomes
Establishes and cultivates helpful and effective contacts in payer or network offices
Monitors and tracks contractual, billing, registration, and posting errors, and provides continuous feedback to Appeals Manager
Participates in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts
Maintains the strict confidentiality required for medical records and other data
Participates in professional development efforts to ensure currency in managed care reimbursement trends

Skills

Contract Manager

EOB Analysis

Claims Appeals

CPT/HCPCS

Payer Relations

Healthcare Billing

Reimbursement Tracking

Expedia

Travel booking platform for flights, hotels, rentals

About Expedia

Expedia Group operates in the travel industry, offering a wide range of services for travelers and travel-related businesses. It connects users with options for flights, hotels, car rentals, vacation packages, and activities through its various brands, including Expedia, Hotels.com, and Vrbo. Travelers can easily find and book trips that match their preferences and budgets. The company earns revenue primarily through commissions on bookings and advertising from travel service providers looking to promote their offerings. Additionally, Expedia Group supports its partners by providing access to valuable data and technology, helping them improve their operations and grow their businesses. The goal of Expedia Group is to create a seamless travel experience for users while maximizing the potential of its partners.

Bellevue, WashingtonHeadquarters

1996Year Founded

$3,277.3MTotal Funding

IPOCompany Stage

Consumer Goods, EntertainmentIndustries

10,001+Employees

Benefits

Competitive Paid Time Off

Travel Discounts

Healthcare Flexible Spending Accounts

Employee Assistance Program

Wellness & Travel Reimbursement

Workplace Accomodations

Medical, Dental, & Vision Insurance

Matching Gifts

New Parental Benefits

Risks

Riyadh Air's entry could increase competition, affecting Expedia's market share.

CFO transition may lead to strategic shifts impacting financial management and investor confidence.

Expedia's partnerships may strain resources, affecting service quality if not managed well.

Differentiation

Expedia offers a comprehensive suite of travel services under one platform.

The company leverages a diverse portfolio of brands like Hotels.com and Vrbo.

Expedia provides partners with valuable data and technology to optimize their offerings.

Upsides

Expedia can capitalize on the rise of 'workcations' with longer stay packages.

The trend of 'bleisure' travel offers opportunities for specialized leisure-business packages.

Increased demand for personalized travel experiences can enhance user engagement for Expedia.

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