Clinical Appeals Analyst (Remote) at Piper Companies

Piper Companies is seeking a Clinical Appeals Analyst to work remotely for a highly accredited health insurance organization to complete the analysis, review, and submission of complex appeals.

Responsibilities of the Clinical Appeals Analyst:

·       Assess, review and finalize non-routine appeals and grievance to ensure member satisfaction

·       Provide clinical expertise with non-clinical staff within the Appeals Department

·       Coordinate all appeals process activities according to compliance and necessity

·       Perform accurate and complete work in a timely and efficient manner

·       Report to the Manager, Nurse Lead/ Team Leader, and Medical Lead

Qualifications of the Clinical Appeals Analyst:

·       3+ years of inpatient care experience in the ER, med/surg, critical care, ICU, or step-down units

·       Experience with EMR/EHR Systems

·       RN or LPN- North Carolina license

·       Associate degree or higher required

*Must be in approved states of NC (preferred), AL, AZ, AR, CO, FL, GA, ID, IN, IA, KS, KY, LA, MD, MI, MS, MO, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI & WY

Compensation for the Clinical Appeals Analyst:

·       Salary Range: $38-41/hr based on relative experience

·       Comprehensive Benefits: Medical, Dental, Vision, 401k

Keywords: Clinical Appeals Analyst, health insurance, RN, LPN, NC, EMR, NCDOI, NCQA, pharmaceutical companies, health care, complex appeals, claims, analysis, research

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