Clinical Appeals Analyst | PAM Health Corporate

Job description

Overview Clinical Appeals Analyst (Remote) - FT The Clinical Appeals Analyst is responsible for assisting the Corporate Director of Appeals Management by conducting a comprehensive analytic review of clinical documentation and complete the appeal process. The Clinical Appeals Analyst will write sound, compelling letters to support the appeal. Responsibilities: - Review patient medical records and utilize clinical and regulatory knowledge and skills, as well as, knowledge of payer requirements to determine why cases/claims are denied and complete an appeal.• Utilize pre-existing criteria and other resources and clinical evidence to develop sound and well-supported appeal arguments.• Prepare convincing appeal arguments, using pre-existing criteria sets and/or clinical evidence from existing library of clinical references and/or regulatory guidelines to prepare the response to the payer in an effort to overturn the denial in a professional and concise manner.• Prepare convincing appeal arguments, using pre-existing criteria sets and/or clinical evidence from existing library of clinical references and/or regulatory guidelines to prepare for an Administrative Law Judge hearing and part...