Clinical Appeals Analyst

Job Summary

Working remotely on a contract basis, the Clinical Appeals Analyst will analyze, research, and resolve appeals and grievances while ensuring compliance with regulatory guidelines and preparing documentation for external reviews.

Key responsibilities

• Analyze and respond to confidential appeals, coding disputes, and grievances from various stakeholders
• Prepare documentation and position statements for external reviews, ensuring compliance with regulatory standards
• Monitor daily reports to ensure service timeliness and compliance with applicable accreditation agency standards

Required qualifications

• 3-5 years of experience in appeals and grievances
• Experience with Medicare and insurance claims
• Strong time management skills
• Ability to interpret health plan benefits and medical terminology
• Familiarity with regulatory and accreditation guidelines