Clinical Appeals Analyst

Ready to make a difference for hospitals while working from home? Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We’re powered by people, driven by technology, and dedicated to our clients and employees. If you’re looking for a collaborative and diverse culture with a great work/life balance, look no further.  

Revecore Perks:

• We offer paid training and incentive plans 
• Our medical, dental, vision, and life insurance benefits are available from the first day of employment   
• We enjoy excellent work/life balance  
• Our Employee Resource Groups build community and foster a culture of belonging and inclusion  
• We match 401(k) contributions  
• We offer career growth opportunities   
• We celebrate 12 paid holidays and generous paid time off    

Location: Remote – USA  

The Role: Clinical Appeals Analyst 

Primarily responsible for thorough review of claim denials from managed care and other insurance carriers and denial management activities related to the collection of denied hospital claims. Handle verbal and/or written appeals requiring clinical input or interpretation, as well as identify coding or clinical documentation issues and work to correct and overturn denials. 

As a Clinical Appeals Analyst, you will: 

• Review and perform retrospective reviews, investigates and appeals all clinical level denials such as not medically necessary inpatient stays or levels of care, authorization or other denial issues 
• Audit Medical Records to retrieve clinical information for appeal, prepare appeal correspondence 
• Utilize online payor portals 
• Review and process correspondence including approvals and denials/adjustments, demand letters and results from various levels of appeals 
• Working with team to monitor, track, trend and coordinate denial resolution with payers 
• Communicates with all parties in a professional manner to alert of specific problem issues 
• Performs other duties as assigned  

You will be successful if you have: 

• Working knowledge of Microsoft Office suite (Word, Excel) 
• Moderate computer proficiency 
• Working knowledge of the revenue cycle 
• Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form 
• Ability to write routine correspondence (in English) 
• Ability to define problems, collect data, establish facts and draw valid conclusions 
• Strong customer service orientation 
• Excellent interpersonal and communication skills 
• Commitment to company values  

Education And Experience Requirements:

• Licensed as an RN or LPN (must possess and maintain a current state nursing license) 
• At least 3 years of experience as a Case Manager or equivalent is desired 
• At least 1 year experience with medical necessity appeals at all levels is preferred 
• Bachelor’s degree desirable, but equivalent job experience will be considered 
• Experience using standardized clinical guidelines; InterQual experience preferred 

Work At Home Requirements:

• A quiet, distraction-free environment to work from in your home.   
• A reliable hard-wired private internet connection that is not supplied via cellular data or hotspot is required.  
• Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.  
• The workspace area accommodates all workstation equipment, related materials, and provides adequate surface area to be productive.  

Revecore is an equal opportunity employer that does not discriminate on the basis of race, color, religion, sex or gender, gender identity or expression, sexual orientation, national origin, age, disability status, veteran status, genetic information, or any other legally protected status.   

We believe that a diverse workforce fosters innovation and creativity, enriches our culture, and enables us to better serve the needs of our clients and communities. We welcome and encourage individuals of all backgrounds, perspectives, and abilities to apply.  

Must reside in the United States within one of the states listed below:   

Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota (CST Time Zone), Tennessee, Texas (CST Time Zone), Vermont, Virginia, Wisconsin, and West Virginia.