Healthcare Appeals Analyst - Remote

Vālenz Health; United States; Remote; USD 70,000 - 110,000; Full time

Benefits offered by this job

Medical, Dental, Vision insurance

HSA/FSA/DCFSa

401K with company match

Flexible working environment

Generous PTO

Employee Assistance Program

Maternity/Paternity leave

Pet insurance

Employee discounts

Community giveback opportunities

Job summary

Valenz Health is recruiting an Appeals Analyst to review provider appeals, price settlements, and ensure compliant determinations. You’ll manage documentation, communicate with clients, and support workflows using Zendesk and MS tools.

Requirements include 2+ years in healthcare claims/appeals, CPT/HCPCS knowledge, and ERISA familiarity. Remote US-based role with HIPAA-compliant work setups and benefits.

Qualifications

• 2+ years of healthcare claims, provider appeals, reimbursement, revenue cycle, or medical billing experience.
• Knowledgeable in CPT-4, HCPCS, Revenue Codes, DRG, and ICD-10 coding for accurate claims review and pricing.
• Familiar with No Surprise Act, ERISA guidelines, and related legislation.
• Detail-oriented with the ability to identify discrepancies and ensure accurate results.
• Experience with reviewing EOBs, contract interpretation, and provider negotiations.

Responsibilities

• Review appeals from providers following SOPs and SLAs, maintaining timely communication.
• Compare reimbursements against plan docs, network agreements, and contract requirements.
• Calculate and propose initial settlement offers using claim history and data.
• Prepare agreement templates detailing negotiated terms for providers.
• Ensure compliance with ERISA and federal/state regulations.
• Document appeal research, negotiations, approvals, and outcomes.
• Record finalized agreements for reference and compliance.
• Communicate status updates and resolutions with clients and providers.
• Utilize Zendesk, internal claims systems, Outlook, and Teams for case management.

Skills

Healthcare claims

Provider appeals

Revenue cycle

CPT/HCPCS

No Surprise Act

ERISA laws

Detail-oriented

Out-of-network reviews

Medicare pricing

EOB review

Contract interpretation

Negotiations

Outlook/Teams/Excel

Education

Associate or bachelor’s degree in healthcare administration

CPC Certification

Job description

Valenz Health is recruiting an Appeals Analyst to review provider appeals, price settlements, and ensure compliant determinations. You’ll manage documentation, communicate with clients, and support workflows using Zendesk and MS tools.

Requirements include 2+ years in healthcare claims/appeals, CPT/HCPCS knowledge, and ERISA familiarity. Remote US-based role with HIPAA-compliant work setups and benefits.