Remote Clinical Appeals & Reimbursement Specialist

Jobgether; Oregon; Hybrid; USD 44,000 - 67,000; Full time

Benefits offered by this job

Fully remote-eligible

Job summary

Jobgether seeks a Clinical Appeal Specialist based in the United States. This role manages healthcare denials, appeals, and reimbursement recovery within a clinical environment.

You will review claims, analyze payer requirements, and develop effective appeal strategies to improve revenue cycle performance. Responsibilities include end-to-end appeals, root-cause analysis, and collaboration with clinical and financial teams.

Qualifications

• Associate's degree in Healthcare, Finance, or related field required.
• RN license active; RN or RN+LPN pathway acceptable per policy.
• Strong knowledge of Medicare/Medicaid reimbursement and payer rules.
• Experience with denial management, appeals, and hospital reimbursement.
• Proficient in Excel and data analysis; able to interpret reimbursement data.

Responsibilities

• Coordinate end-to-end denials review and appeals management.
• Review denied claims, investigate issues, and pursue financial recovery.
• Analyze payer policies and regulatory requirements for appeals.
• Evaluate documentation and coding accuracy to support adjudication.
• Apply Medicare/Medicaid and managed care knowledge to resolve disputes.
• Identify denial patterns and recommend corrective actions.
• Monitor reimbursement practices and ensure regulatory compliance.
• Use data tools to track denial trends and inform decisions.
• Collaborate with clinical, financial, and administrative teams.
• Maintain documentation and meet established timelines.

Skills

Denials management

Appeals processing

Healthcare reimbursement

Regulatory compliance

Medical coding knowledge

Excel data analysis

Effective communication

Independent research

Education

Associate's degree in Healthcare or Finance

Active RN licensure

Bachelor's degree + 5+ years healthcare exp. with RN

LPN path to RN licensure eligibility

Tools

Soarian

Microsoft Excel

Microsoft Access

Job description

Jobgether seeks a Clinical Appeal Specialist based in the United States. This role manages healthcare denials, appeals, and reimbursement recovery within a clinical environment.

You will review claims, analyze payer requirements, and develop effective appeal strategies to improve revenue cycle performance. Responsibilities include end-to-end appeals, root-cause analysis, and collaboration with clinical and financial teams.