Experian Healthcare Analyst II - Experian Health in Heredia, Costa Rica

Job Description - Healthcare Analyst II - Experian Health (171190)

Experian is an Equal Opportunity Employer

Healthcare Analyst II - Experian Health-Job Number:171190


The Healthcare Appeals Analyst is responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.

Essential Functions:

• Implements process for identifying under-allowed claims using software and other available tools.

• Reviews and analyzes EOBs for identified under-allowed claims.

• Verifies applicable contract by, as dictated by operational procedures: reviewing EOB messages, reviewing patient ID card, verifying member information for managed care plans.

• Uses feedback and experience to refine communication skills and tools for use in preparing written and telephone appeals.

• 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 software to track appeals and recoveries.

• Establishes and cultivates helpful and effective contacts in payer or network offices.

• Establishes follow-up protocol with payers and networks.

• Prepares monthly performance statistics regarding appeals and recoveries.

• 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.


Education and Experience:

• Associates degree preferred

• Minimum of two years’ experience working with managed care claims and appeals for health care professional services (physicians and other health care professionals).

• Experience in a production environment desirable but comfort in such an environment is essential.

Equivalent combination of education and experience may be considered


• Advanced knowledge and PC skills, with proficiency in utilizing Microsoft office products (Word, Excel, Outlook, PowerPoint, etc.)

• 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 highly desirable.

• Knowledge of medical terminology.

• Knowledge of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.

• Knowledge of managed care contracts and compliance.


• Demonstrated skill in gathering and reporting claims information.

• Demonstrated skill in written and oral communication with colleagues, supervisors, and payer/network personnel.

• Demonstrated skill working in a team-oriented structure to achieve goals.

• Demonstrated skill in problem solving and research.


• Ability to work effectively with other departments and management.

• Ability to identify, analyze and solve problems and to recognize patterns in data.

• Ability to learn, understand and use the software application.


Primary Location:Costa Rica-Heredia-Heredia


Job Posting:07/12/2017, 12:28:36 AM


Equal Employment Opportunity Statement

It is the policy of Experian to provide equal employment opportunities to all employees and applicants for employment. All employment practices such as recruitment, selection, promotions, and other terms and conditions of employment are administered in a manner designed to ensure that employees and applicants for employment are not subjected to discrimination on the basis of race, color, religion, sex, national origin, age, disability, marital status, medical condition, pregnancy, disability, veteran status, sexual orientation, gender expression or identity, genetic information or any other protected characteristic under applicable law.

This policy relates to all phases of employment, including, but not limited to, recruiting and/or recruitment advertising and selection for hire. As part of the company’s equal employment opportunity and affirmative action policy, Experian will also take affirmative action as called for by applicable laws and Executive Orders to ensure that minority group individuals, females, disabled veterans, recently separated veterans, other protected veterans, Armed Forces service medal veterans, and qualified disabled persons are introduced into our workforce and considered for promotional opportunities.

Experian is committed to providing a work environment free from discrimination and harassment, and where Experian applicants and employees are treated with respect and dignity. This policy is in accordance with State and Federal laws and reaffirms our company’s continuing commitment to both the spirit and intent of Equal Employment Opportunity laws and policies.

Reasonable Accommodation

Experian provides reasonable accommodation so that qualified applicants with a disability may participate in the selection process. Please advise us of any accommodations you request in order to express interest in a position by e-mailing: talentacquisitonops@experian.com or 714-830-5022. Please state your request for assistance in your message. Only reasonable accommodation requests related to applying for a specific position within Experian will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Experian.