Clinical Appeal Specialist
Jobgether
This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Clinical Appeal Specialist based in the United States. As a Clinical Appeal Specialist, you will play a key role in managing healthcare denials, appeals, and reimbursement recovery processes within a complex clinical environment. You will help ensure that medical claims are accurately reviewed, appropriately reimbursed, and aligned with applicable healthcare regulations and payer requirements. Working closely with clinical, financial, and administrative teams, you will investigate denied claims, identify underlying issues, and develop effective appeal strategies. Your expertise in healthcare reimbursement, medical coding, and insurance policies will contribute to improving financial outcomes and reducing recurring denials. You will also analyze denial trends and recommend process improvements to strengthen revenue cycle performance. This is an opportunity to combine clinical knowledge, analytical thinking, and attention to detail in a fully remote-eligible position. We appreciate your interest and wish you the best! #J-18808-Ljbffr
- ...Centene Corp. is seeking a Clinical Review Clinician - Appeals to conduct clinical reviews for appeals, assessing medical necessity from records and data. The role is fully remote but aligned with NY location and Day shift in a full-time schedule. The ideal candidate will...SuggestedFull timeRemote workDay shift
- ...Centene Management Company LLC is seeking a fully remote RN-based reviewer to resolve appeals by examining medical records and clinical data for medical necessity in line with NCQA standards. The role prefers NYS licensure (RN/BSN) with CCM or similar certification, and...SuggestedRemote work
- ...Centene Corporation is seeking an Appeals Liaison to act as the statewide contact for appeals, fair hearings, and external reviews. This remote role requires WA licensure and aligns with NCQA standards, with hours 8:00 am–5:00 pm PST, Monday–Friday. The role emphasizes...SuggestedRemote workMonday to Friday
$83.1k - $120.36k
Position Summary:The Appeals & Grievances (A&G) unit manages Healthfirst member complaints... ...to the authorization of or delivery of clinical and non-clinical services. A&G works in... ...and compliant manner. The A&G Clinical Specialist is the subject matter expert responsible...SuggestedFull timeContract workTemporary workWork experience placementLocal areaRemote work- Investigate denied claims and appeal strategies. Analyze payer policies and trends. Recommend revenue cycle improvements. Requirements... ...cancer care. They are a collaborative remote team blending clinical, financial, and administrative expertise. #J-18808-Ljbffr Partner...SuggestedRemote job
- ...improving patient outcomes within cancer care. This role supports revenue cycle optimization by evaluating denied claims and developing appeal strategies. The candidate brings an active RN license, reimbursement knowledge, and experience with medical coding and payer...Remote job
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances (A&G) unit...Remote jobFull timeMonday to FridayShift work$76k
...BPO Clinical Review Specialist Location: United States Position is fully remote only in the state of Florida. Must live in State of Florida and... ...benefits. Required Qualifications 3 years of experience in appeals processing, utilization management, case management, or...Permanent employmentTemporary workLive inImmediate startRemote workRelocationFlexible hours- ...Job Summary The PRN Remote Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital... ...and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers...Work experience placementReliefRemote work
- ...Medtronic plc is seeking a Cardinal Rhythm Management Clinical Specialist to support the Atlanta territory. The role focuses on technical support for CRM devices, clinical education, and collaboration with sales to meet customer needs and objectives. Applicants must have...Weekend work
- ...Equip is a fully virtual company delivering evidence-based eating disorder treatment. We are hiring a Clinical Partnerships Representative to drive patient access by building strategic relationships with healthcare providers and community organizations across the United...Remote work
- ...BIOTRONIK in Brooklyn, NY is seeking a Field Clinical Specialist to support pacemaker and ICD implants, provide clinical education, and collaborate with physicians across the territory. The role requires a Bachelor’s degree in a related field and 3+ years in cath/EP labs...
$195k - $225k
...Territory : DC, PA, MD, DE, WV & VA We’re looking for a driven Clinical Oncology Specialist (COS) to join our newly established Cutaneous Oncology specialty team. This is a high-impact, tumor-specific role focused on accelerating the adoption and growth of Signatera...Work at officeImmediate startRemote workWorldwideNight shift- ...Abbott is seeking a CRM Product Support Specialist in Gainesville, FL, within the Cardiac Rhythm Management division. You will respond... ...sales staff, delivering engineering, sales, educational, and clinical support. Qualifications include a Biomedical Engineering degree...Remote work
$65k - $75k
...millions of Americans and proudly leading the next generation of care. To learn more, visit Position Summary The Clinical Programs Specialist provides operational and administrative support for the day-to-day management of clinical programs and clinical vendor partnerships...Work at officeLocal areaRemote workFlexible hours- ...ACHC is currently recruiting a personable and detail-oriented Part-Time Clinical Review Specialist to perform the associated duties which support and accomplish the accreditation process for the community based programs to include Home Health & Hospice programs. This...Part timeWork at officeRemote work
- ...Abbott is seeking a Clinical Specialist, Vessel Closure, in Phoenix South. This field-based role focuses on case planning, coverage, and product pull-through across the territory and region. You will educate customers on the merits and proper clinical usage, attend procedures...Remote work
$86.7k - $173.3k
...monitors performance and reports status to manager. Technical proficiencies and performance are at the highest level of all Clinical Specialists in the region. Acts as the most senior clinical interface between the medical community and business. Demonstrates...Remote work- ...Abbott is a global healthcare leader seeking a CRM Associate Clinical Specialist to provide engineering, sales, educational and clinical support in a field-based role based in Lancaster, PA. The position serves as a clinical interface with physicians and healthcare staff...Remote work
$85k - $160k
...environment that is diverse and dynamic, look no further — Haemonetics is your employer of choice. Job Details The Senior Clinical Specialist will work with the Regional Sales Director within the Upstate NY territory to meet existing and potential clients (e.g.,...Hourly payTemporary workLocal areaMonday to FridayFlexible hours- ...Sarah Cannon Research Institute (SCRI) is seeking a Reconciliation Specialist for a remote role based in the United States. You will reconcile clinical trial receivables, review contracts and budgets, and coordinate with operations to ensure accurate and timely billing...Remote work
- ...advancing the treatment of heart disease through electrophysiology products. This role provides engineering, sales, educational and clinical support to physicians, health care professionals, patients and field staff, with independence and strategic input. The candidate...Remote work
- ...Tempus AI in New York is seeking a skilled ontology engineer to standardize clinical concepts and integrate Terminology services across the company. You will collaborate with cross-functional teams to maintain and extend modeled ontology solutions for real-world healthcare...
$78.8k - $131.3k
## .Clinical Analytics Specialist – MD page is loaded## Clinical Analytics Specialist – MDlocations: Texas: Home based-New York: Virginia: Home based-Pennsylvania: Home based-New Jerseytime type: Full timeposted on: Posted Todayjob requisition id: R110146Clinical Analytics...Local areaWork from home- ...our dynamic dental team. Duties and Responsibilities Provide training on dental & ortho products to dentists/assistants,.. Provide clinical training to internal staff (sales team, channel partners team) Provide group training/LnL to able support dentists, clinics,...H1bRelocation package
- ...Abbott is seeking a Senior Field Clinical Specialist in Electrophysiology for the Southeast region. The role focuses on technical and clinical support for EP BU technologies, assisting clinical affairs, and representing Abbott in clinical trials and sites. You will travel...Remote work
- ...You’ll Work On Under general direction, the CRM Product Support Specialist provides comprehensive engineering, sales, educational, and... ...CRM (Cardiac Rhythm Management) products. Key Responsibilities Clinical Interface: Acts as a clinical interface between the medical community...Work at officeRemote workWorldwideShift work
- ...Medtronic plc in the United States is seeking a Clinical Specialist to provide detailed technical support for Superficial Venous Interventions products and procedures. You will train physicians, nurses, and technicians, support field sales, and cover critical cases requiring...
$61.3k - $122.7k
...vessel closure devices, peripheral stents, thrombectomy catheters and atherectomy devices. We currently have an opportunity for a Clinical Specialist, Vessel Closure, in Lexington, KY. The Clinical Specialist will primarily be responsible for case planning, case support...Work experience placementWork at officeRemote workShift work- ...Clinical SpecialistOrganOx is a commercial stage organ technology company dedicated to developing technologies to improve outcomes for... ...sciences in more than 160 countries and regions.The Clinical Specialist will be primarily responsible for training and supporting users...Night shift
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