Healthcare Appeals Analyst

Posted 8 days ago

virtual vocationsNew York (NY)

Administrative Law Judges, Adjudicators, and Hearing Officers All Other Miscellaneous Ambulatory Health Care Services

SENIORITY

Senior

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About the role

Reviewing provider appeals in a full-time remote capacity, the Healthcare Appeals Analyst will apply established procedures and regulations to ensure accurate claim determinations, negotiate settlement offers, and maintain detailed records of appeal activities.

Key responsibilities: Review appeals from providers while adhering to Standard Operating Procedures (SOPs) and maintaining timely communication Calculate and propose settlement offers based on claim history and relevant data Prepare and issue denial determinations based on appeal reviews, ensuring compliance with applicable policies Required qualifications 2+ years of experience in healthcare claims, provider appeals, or medical billing Knowledge of CPT-4, HCPCS, Revenue Codes, DRG, and ICD-10 coding Familiarity with ERISA guidelines and the No Surprise Act Proficiency in Microsoft Outlook, Teams, and Excel Experience in provider negotiations and evaluating counter offers for claim settlements

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A number in mind

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Your notice period

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Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.