Clinical Appeal Specialist

Jobgether; United States; Remote; USD 65.000 - 90.000; Vollzeit

Zusammenfassung

Jobgether is seeking a Clinical Appeal Specialist based in the United States to manage healthcare denials, appeals, and reimbursement recovery in a fully remote role. You will review medical claims, build persuasive appeals, align with payer requirements, and collaborate with clinical and finance teams to strengthen revenue cycle performance.

The role emphasizes analytical thinking, attention to detail, and knowledge of coding, payer policies, and regulatory guidelines.

Qualifikationen

• Experience handling healthcare denials and appeals.
• Knowledge of reimbursement processes and payer requirements.
• Analytical mindset with attention to detail.

Aufgaben

• Review denied claims and prepare appeals.
• Develop effective strategies to maximize reimbursement.
• Analyze denial trends and suggest process improvements.

Kenntnisse

Denials management

Medical coding

Payer policies

Analytics

Jobbeschreibung

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Clinical Appeal Specialist based in the United States.

As a Clinical Appeal Specialist, you will play a key role in managing healthcare denials, appeals, and reimbursement recovery processes within a complex clinical environment. You will help ensure that medical claims are accurately reviewed, appropriately reimbursed, and aligned with applicable healthcare regulations and payer requirements. Working closely with clinical, financial, and administrative teams, you will investigate denied claims, identify underlying issues, and develop effective appeal strategies. Your expertise in healthcare reimbursement, medical coding, and insurance policies will contribute to improving financial outcomes and reducing recurring denials. You will also analyze denial trends and recommend process improvements to strengthen revenue cycle performance. This is an opportunity to combine clinical knowledge, analytical thinking, and attention to detail in a fully remote-eligible position. We appreciate your interest and wish you the best!