clinical appeals analyst

Summary: The role of Appeals Analyst involves analyzing and resolving confidential appeals, coding disputes, and grievances for a market-leading managed care organization. This position is remote and requires adherence to regulatory and accreditation guidelines while responding to various stakeholders. The analyst will interpret and evaluate complex information to ensure compliance and effective resolution of issues.

Key Responsibilities:

• Analyze, research, resolve and respond to confidential/sensitive appeals, coding disputes, grievances, and coverage/organization determinations.
• Engage with members, member's representatives, providers, media outlets, senior leadership, and regulatory agencies.
• Ensure compliance with established regulatory and accreditation guidelines.
• Interpret and evaluate complex information related to appeals and disputes.

Key Skills:

• Strong analytical and research skills.
• Experience in managed care or healthcare settings.
• Knowledge of regulatory and accreditation guidelines.
• Excellent communication skills for stakeholder engagement.

Salary (Rate): £25.00 hourly

City: Aberdeen

Country: United States

Working Arrangements: remote

IR35 Status: outside IR35

Seniority Level: undetermined

Industry: Other