Piper Companies · 13 hours ago
Clinical Appeals Analyst
United States
Full-time
Remote
Mid Level
$69K/yr - $79K/yr
3+ years expPiper Companies is seeking a Clinical Appeals Analyst to join a leading organization in the health-insurance industry for a fully remote contract position. The Clinical Appeals Analyst will support clinical review activities, coordinate appeals workflows, and ensure compliance with regulatory and medical-necessity standards.
Management Consulting
Responsibilities
Conduct clinical reviews for member and provider appeals while ensuring compliance with state, federal, and accreditation requirements
Provide clinical consultation to non-clinical appeals staff and collaborate with physicians and internal leadership
Analyze complex documentation, gather required information from external sources, and present case summaries for determination
Prepare written case determinations, initiate claim adjustments when necessary, and manage required turnaround times
Identify trends, high-risk issues, and process gaps to recommend internal education or corrective action
Qualification
Required
Active Registered Nurse license in your state
Minimum of 3 years of clinical experience for RN applicants
Experience with Medicare or Medicare Advantage programs
Telephonic appeals, case management, or utilization management experience
Strong ability to interpret medical policy, CMS guidelines, and regulatory requirements
Benefits
Medical
Dental
Vision
Sick leave if required by law
401K
Company
Piper Companies
At Piper, we obsess about the success of our customers and consultants.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Justin Jordan
Founder and Chairman
Company data provided by crunchbase