Healthcare Appeals Analyst

Job Summary

Passionate about healthcare and compliance, the full-time temporary Healthcare Appeals Analyst will analyze and resolve appeals, grievances, and coding disputes in a remote environment, ensuring compliance with regulatory standards and enhancing member experience.

Key responsibilities

• Analyze and respond to confidential appeals and grievances in accordance with regulatory guidelines
• Prepare comprehensive case files for external reviews and draft compliant responses supporting determinations
• Monitor daily reports to ensure timeliness and compliance with service-level agreements

Required qualifications

• Bachelor's degree or advanced degree where required
• 3 years of related experience (or 5 years in lieu of a degree)
• Ability to analyze complex information and apply policies with sound judgment
• Strong written communication skills for drafting detailed responses
• Willingness to obtain Certified Professional Coder (CPC) credential within 1 year if supporting coding disputes