Clinical Analyst Appeals

Job Summary

Clinical Analyst Appeals is a full-time remote position responsible for managing clinical appeals and audits, ensuring compliance with regulations, and providing support and guidance to healthcare providers.

Key Responsibilities

• Manage and report on clinical appeals, audits, and compliance issues to leadership
• Prepare and defend claims denials and adverse audit results while analyzing denial trends
• Conduct training on coding, billing, and documentation requirements for healthcare providers

Required Qualifications

• Associate degree in business, healthcare, or finance, or 4 years of healthcare revenue cycle experience in lieu of a degree
• Minimum of 2-3 years of auditing experience with CPT/HCPCs/DRG coding
• Clinical education and/or utilization review experience preferred
• 2 years of healthcare revenue cycle experience required
• Applicable clinical or professional certifications/licenses are highly desirable