Clinical Appeals and Denial Analyst

Ensures timely and effective responses to clinical denials and audit findings, supporting the appeals process by providing analytical insight, maintaining documentation standards, and facilitating communication between internal stakeholders and external payors. The role helps ensure compliance, reduce revenue loss, and improve outcomes related to governmental and commercial audits.

Minimum Qualifications

One of the following:

• Bachelor’s degree in business administration
• Bachelor’s degree in healthcare administration
• 4 of the most recent 6 years’ experience working in healthcare insurance or billing

Also:

• Basic knowledge of the revenue cycle (e.g. billing, reimbursement)
• Strong oral and written communication skills
• Excellent organizational skills and attention to detail
• Ability to manage multiple tasks simultaneously
• Proficiency in personal computer use, including word processing, spreadsheets, data entry, email, scanning, and Adobe applications

Desired Qualifications

• Working knowledge of Midas report writing software