Appeals Administrator

At XSOLIS, the Appeals Admin work with our clients and client representatives to investigate denied claims, document investigation, and work to effect reimbursement for denied services.

The Appeals Analyst will need a strong understanding of clinical policies, contracts, and regulations to guide research into claim denials.

Aside from the technical know-how, a successful Appeals Analyst will also have the soft-skills necessary to build relationships with clients, payers, and providers and the ability to draft a convincing argument for reimbursement.

Essential Duties & Responsibilities The essential functions include, but are not limited to the following: Ability to resolve claims by reviewing supporting documentation; calculating benefits due; initiating payment or composing appeal letters; guiding resolution of non-routine claims; auditing claims to ensure appropriate payment.

Ability to maneuver through multiple facility patient accounting systems Assists in creating reports by securing analytical information through to a finished product Work with Appeals Analysts to analyze claims to determine validity of denial/recovery options from client inventories and formulate recovery resolution Clearly and concisely document all actions taken to resolution within a claims recovery system Provide support to the Appeals team Familiarity with Microsoft Office products, Access, provider and payer operating systems a plus.

Minimum Qualifications (Knowledge, Skills, and Abilities) Superior verbal, written, customer service, and analytical skills Well versed in MS Office Products specifically with Excel advanced proficiency.

Knowledge of reimbursement solutions Good negotiating skills with problem recognition and resolution skills Ability to effectively drive several tasks/roles at any given point Ensures legal compliance by following guidelines, contracts, regulations, and the company's business plan Maintains quality service by following corporate provider and payer service practices and protocols.

Ability to multi-task and work in a team environment