Clinical Analyst Appeals

Job Summary

A company is looking for a Clinical Analyst Appeals (Remote).

Key Responsibilities

• Manage clinical appeals, audits, and compliance reporting to ensure adherence to regulations
• Prepare and defend appeal requests for claims denials and adverse audit results
• Conduct audits and provide recommendations for clinical documentation improvements

Required Qualifications

• Associate degree in business, healthcare, or finance; or 4 years of relevant healthcare revenue cycle experience
• Applicable clinical or professional certifications/licenses such as RN, LPN, CPC, or similar are highly desirable
• 2-3 years of auditing experience with familiarity in CPT/HCPCS/DRG coding
• Minimum of 2 years of healthcare revenue cycle experience
• Experience with Epic Resolute HB is preferred