Clinical Analyst Appeals in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Clinical Analyst Appeals in United States.

This role is an excellent opportunity for a healthcare revenue cycle professional with strong clinical and analytical expertise to contribute to a high-impact appeals and compliance function. You will play a key role in reviewing complex clinical denials, preparing detailed appeals, and supporting audit processes across inpatient and outpatient services. Working within a collaborative healthcare environment, you will help ensure compliance with federal and state regulations while improving reimbursement outcomes and operational efficiency. The position combines clinical analysis, payer communication, documentation review, and process improvement initiatives to support organizational performance. Ideal candidates are detail-oriented, highly organized, and passionate about driving accuracy and compliance within healthcare operations. This role offers meaningful visibility, cross-functional collaboration, and the opportunity to influence revenue cycle improvement strategies.

• Review and prepare clinical appeals for denied inpatient and outpatient claims, ensuring medical necessity and level of care are accurately supported.
• Analyze payer denials, audit findings, and reimbursement trends to identify root causes and recommend corrective actions.
• Conduct coding, billing, and documentation audits to ensure compliance with applicable healthcare regulations and reimbursement guidelines.
• Maintain detailed reporting systems for appeals, audits, denials, and compliance-related activities, providing timely updates to leadership teams.
• Collaborate with hospital departments and providers to improve clinical documentation, billing accuracy, and denial prevention initiatives.
• Support complex projects related to denial management, audit defense, and revenue cycle optimization efforts.
• Participate in meetings with payers and provider representatives to resolve outstanding claims and address recurring processing issues.
• Develop and deliver educational materials and training sessions related to coding, billing, compliance, and documentation best practices.
• Investigate potential billing discrepancies, fraud concerns, or reimbursement issues while supporting organizational compliance efforts.

• Associate degree in healthcare, business, finance, or a related field; equivalent healthcare revenue cycle experience may substitute for formal education.
• 2–3 years of experience in auditing, healthcare appeals, utilization review, or healthcare revenue cycle operations.
• Strong knowledge of ICD-10, CPT, HCPCS, and DRG coding systems, as well as Medicare rules and reimbursement methodologies.
• Experience reviewing medical records, clinical documentation, billing practices, and payer denial management processes.
• Familiarity with healthcare revenue cycle systems and reporting tools; Epic Resolute HB experience preferred.
• Clinical or professional certifications such as RN, LPN, CPC, RT, MT, or RPH are highly desirable.
• Excellent analytical, organizational, research, and problem-solving skills with strong attention to detail.
• Strong verbal and written communication skills with the ability to interact effectively across clinical, administrative, and leadership teams.
• Proficiency with Microsoft Office tools including Excel, Outlook, Access, and other Windows-based applications.
• Ability to manage multiple priorities, work independently, and contribute to process improvement initiatives in a fast-paced environment.

• Competitive annual salary ranging from $93,142 to $124,800 USD.
• Comprehensive healthcare, medical, and wellness benefits package.
• Opportunities for professional growth, continuous learning, and career development.
• Collaborative and mission-driven healthcare environment focused on innovation and patient care excellence.
• Supportive workplace culture that values teamwork, inclusion, and employee wellbeing.
• Access to quality improvement initiatives and cross-functional project involvement.
• Paid time off and work-life balance support programs.
• Participation in a healthcare organization committed to employee and community wellbeing.