Health Plan Appeal & Policy Analyst

Located in the heart of Anderson, South Carolina, AnMed is a dynamic, not-for-profit health system dedicated to delivering exceptional care with compassion, innovation, and integrity. At AnMed, our mission is simple yet powerful: To provide exceptional and compassionate care to all we serve. AnMed has been named one of the Best Employers in South Carolina by Forbes, reflecting our commitment to a supportive, inclusive, and purpose-driven workplace. Whether youre just starting your career or looking to grow in a new direction, youll find opportunities to thrive, lead, and make a meaningful impact here. Summary Responsible for the resolution of disputes on escalated claims, utilization management, or other denials. Reviews any changes to health plans policy and procedures, recommending changes where appropriate. Maintains Managed Care contract inventory, reports, tracking grids and related processes. Responsibilities -Research Issues using EPIC, Health Plan Policies, guidelines Tools, discussing with subject matter expertsto develop appeal -Prepare escalation grids for health plan and joint committees in a timely/accurate fashion -Stay appraised on changes to health plan policies/guidelines reporting to Health Plan Policy Changes group -Identify areas of revenue reduction and operational inefficiencies -Maintain minutes of HP Policy Changes group as well as Managed Care contracts Sharepoint site -Administer Managed Care Contract Process, ensuring stakeholders are notified, EPIC Contract files are updated,and route tracker is maintained -Perform stakeholder education sessions for Managed Care Contract Process Qualifications: Bachelors Degree in Business Administration, Healthcare Administration or related field and2-4 years experience in managed care, appeals, grievances, utilization management, or revenue cycle 8+ years of experience requiredwithoutBachelors degree; Proficiency in Microsoft Office (Excel and Word) Excellent communication/professional writing/interpersonal skills Superior analytical, investigation problem solving skills Ability to manage time well, staying organized/meeting deadlines Benefits Medical Insurance Wellness Offerings Compensation, Retirement Financial Planning Free Financial Counseling Work-Life Balance Paid Time Off (PTO) Professional Development For more information, please visit: anmed.org/careers/benefits Varied benefits packages are available to positions with a 0.6 FTE or higher