Remote Healthcare Appeals Analyst

Vālenz Health®; Phoenix (AZ); Remote; USD 64,000 - 90,000; Full time

Benefits offered by this job

Health insurance

401K with match

Remote-friendly

Paid time off

Job summary

Valenz Health is recruiting an Appeals Analyst to review provider appeals, ensure accurate determinations, and coordinate negotiations in a remote US-based role. The position emphasizes adherence to SOPs, SLAs, and plan documents, with a focus on pricing accuracy and compliance.

The role requires 2+ years in claims or provider appeals, knowledge of CPT/ICD-10, and experience with tools like Zendesk, Outlook, and Teams. A CPC or healthcare admin degree is preferred.

Qualifications

• 2+ years of healthcare claims, provider appeals, reimbursement, revenue cycle, or medical billing experience.
• Knowledge of CPT-4, HCPCS, Revenue Codes, DRG, and ICD-10 coding for accurate claims review, pricing, and payment validation.
• Knowledge of the No Surprise Act, ERISA guidelines, and related legislation.
• Highly detail-oriented with the ability to identify discrepancies and ensure accurate results.
• Proficient in analyzing out-of-network claim appeals using pricing tools and data.
• Knowledgeable of Medicare reimbursement methodologies.
• Proficient in reviewing EOBs to identify payment discrepancies and support appeal resolutions.
• Ability to interpret contracts and Plan documents for accurate adjudication.

Responsibilities

• Review appeals from providers following SOPs and SLAs.
• Compare reimbursement findings against plan documents, network agreements, and contract requirements.
• Calculate and propose initial settlement offers based on data and history.
• Prepare agreement templates detailing negotiated terms for providers.
• Support compliance with ERISA and federal/state regulations.
• Maintain documentation of appeal research, negotiations, approvals, and outcomes.
• Record finalized agreements for future reference and compliance.
• Communicate updates to clients on statuses and outcomes.
• Issue denial determinations when appropriate.
• Coordinate with clients when approvals exceed delegated authority.

Skills

Healthcare claims knowledge

No Surprise Act/ERISA knowledge

Contract interpretation

Provider negotiations

Microsoft Excel

Outlook/Teams proficiency

Attention to detail

HIPAA compliance

Education

Associate or bachelor’s degree in healthcare administration

CPC Certification

Tools

Zendesk

Internal claims systems

Microsoft Outlook

Microsoft Teams

Job description

Valenz Health is recruiting an Appeals Analyst to review provider appeals, ensure accurate determinations, and coordinate negotiations in a remote US-based role. The position emphasizes adherence to SOPs, SLAs, and plan documents, with a focus on pricing accuracy and compliance.

The role requires 2+ years in claims or provider appeals, knowledge of CPT/ICD-10, and experience with tools like Zendesk, Outlook, and Teams. A CPC or healthcare admin degree is preferred.