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 on a contract basis.

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
• Document findings and monitor daily reports to ensure compliance and service timeliness

Required qualifications

• 3-5 years of experience in clinical appeals, grievances, or insurance
• Experience with Medicare and claims processing
• Strong time management skills
• Ability to interpret health plan benefits and medical terminology
• Familiarity with regulatory and accreditation standards (e.g., NCQA, CMS)