Job Description

To support a high-profile team, the full-time Clinical Analyst Appeals will manage clinical appeals and audit processes for both commercial and government services in a remote setting, ensuring compliance with federal and state regulations related to coding, billing, and documentation. Key responsibilities Maintain reporting systems for clinical appeals, audits, and compliance issues, providing timely information to management Prepare and defend appeal requests against claims denials and adverse audit results while tracking payer audit outcomes Conduct regular audits to ensure compliance with coding, billing, and documentation standards, and provide recommendations for clinical improvement initiatives Required qualifications Associate degree in business, healthcare, or finance, or 4 years of healthcare revenue cycle experience in lieu of a degree Minimum of 2-3 years of auditing experience and familiarity with CPT/HCPCs/DRG coding Applicable clinical or professional certifications such as RN, LPN, CPC, RT, MT, or RPH are highly desirable Experience with Epic Resolute HB is preferred Thorough understanding of ICD-10 coding systems and Medicare rules and regulations

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