Clinical Editing & Claims Dispute Analyst - Remote

Jobrapido; Chattanooga (TN); Remote; USD 47,000 - 71,000; Full time

Benefits offered by this job

Remote work option

Job summary

Jobrapido is seeking a Clinical Editing Dispute Review Analyst 1 to research, review, and resolve clinical editing inquiries, claims disputes, and appeals. You will collaborate with Medical Directors, Claims, Provider Services, and external vendors to ensure accurate claims processing and timely provider reimbursement.

You will coordinate with multiple stakeholders, track inquiries, monitor turnaround times, and help prepare weekly metrics while maintaining compliant documentation.

Qualifications

• Bachelor's degree and three years of relevant claims operations or customer service experience, or five years of equivalent relevant experience.
• CPC certification preferred; enrollment in a CPC course required within one year if not certified.
• Knowledge of medical coding, claims adjudication, reimbursement methodologies, and clinical editing tools.
• Proficiency in spreadsheets, databases, and claims processing systems.
• Strong analytical, communication, organizational, and problem-solving skills.
• Attention to detail, customer service orientation, and ability to work independently.

Responsibilities

• Research and resolve clinical editing inquiries, claims disputes, and appeals.
• Coordinate with Medical Directors, providers, internal teams, and vendors to obtain necessary information.
• Track inquiries, monitor turnaround times, and maintain review databases and logs.
• Communicate review decisions and resolutions to providers and stakeholders.
• Support claim adjustments, claims research, and appeals processing.
• Prepare weekly metrics, identify trends, and recommend process improvements.
• Ensure accurate documentation and compliance with established procedures.

Skills

Medical coding

Claims adjudication

Reimbursement methodologies

Clinical editing tools

Spreadsheets

Databases

Claims processing systems

Analytical skills

Communication

Organizational skills

Problem solving

Attention to detail

Customer service

Independent work

Education

Bachelor's degree

CPC certification

Tools

Spreadsheets

Databases

Claims processing systems

Job description

Jobrapido is seeking a Clinical Editing Dispute Review Analyst 1 to research, review, and resolve clinical editing inquiries, claims disputes, and appeals. You will collaborate with Medical Directors, Claims, Provider Services, and external vendors to ensure accurate claims processing and timely provider reimbursement.

You will coordinate with multiple stakeholders, track inquiries, monitor turnaround times, and help prepare weekly metrics while maintaining compliant documentation.