Clinical Appeal Specialist

📋 Description

• Coordinate and administer the end-to-end denials review and appeals management processes, including
• Review denied healthcare claims, investigate reimbursement issues, and identify opportunities for
• Analyze payer policies, reimbursement methodologies, regulatory requirements, and administrative
• Evaluate medical documentation, billing information, and coding accuracy to support claims
• Apply knowledge of Medicare, Medicaid, commercial insurance, and managed care requirements when
• Identify recurring denial patterns, investigate underlying causes, and recommend corrective actions

🎯 Requirements

• Associate's degree in Healthcare, Finance, or a related field is required.
• Alternatively, candidates must meet one of the following educational and professional experience
• Bachelor's degree combined with at least five years of healthcare experience and an active
• Associate's degree combined with at least seven years of healthcare experience, preferably in
• Active RN licensure is required. Current LPNs working in Clinical Denial Specialist positions may
• Strong knowledge of healthcare reimbursement, including benefit investigations, payer reimbursement

🎁 Benefits

• Annualized salary range: $31.99–$48.80 per hour, depending on qualifications, experience, skills
• Fully remote-eligible working arrangement.
• Opportunity to contribute to a meaningful healthcare mission focused on improving patient outcomes
• Collaborative professional environment bringing together clinical, financial, and administrative
• Opportunity to apply and develop specialized knowledge in healthcare reimbursement, claims
• Equal employment opportunities and reasonable accommodations throughout the recruitment and