Clinical Appeals Analyst

Job Summary

Working remotely on a contract basis, the Clinical Appeals Analyst will analyze and resolve appeals, coding disputes, and grievances while ensuring compliance with regulatory guidelines and providing comprehensive responses to support decision-making.

Key responsibilities

• Analyze and respond to confidential appeals and coding disputes from various stakeholders
• Prepare files and develop position statements for external reviews by independent organizations
• Monitor daily reports to ensure compliance with service timeliness and regulatory standards

Required qualifications

• 3-5 years of experience in appeals and grievances
• Experience with Medicare and insurance processes
• Claims experience
• Strong time management skills