Clinical Appeals Analyst

Job Summary

To support a leading managed care organization, the remote Clinical Appeals Analyst will analyze and resolve appeals, coding disputes, and grievances while ensuring compliance with regulatory guidelines in a contract position.

Key responsibilities

• Analyze and respond to appeals, coding disputes, and grievances from various stakeholders while adhering to established guidelines
• Prepare files and develop position statements for external reviews, ensuring comprehensive documentation of investigations and findings
• Monitor daily reports to ensure service timeliness and compliance with state and federal accreditation standards

Required qualifications

• 3-5 years of experience in appeals and grievances, insurance, or claims
• Experience with Medicare and familiarity with medical terminology and coding
• Strong time management skills