Appeals Analyst

Location: Fully remote, US-based candidates only. A quiet workspace, reliable internet, approved devices, VPN use, and compliance with HIPAA-related company policies are required.

Company

hirify.global uses technology, clinical expertise, and healthcare data to improve cost containment, quality, utilization, and payment integrity.

What you will do

• Review provider appeals against SOPs, SLAs, plan documents, network agreements, and contract requirements.
• Analyze reimbursement findings, claim histories, pricing data, EOBs, and out-of-network claims to determine accurate payment outcomes.
• Calculate settlement offers, evaluate counteroffers, negotiate terms, and prepare agreement documentation for providers.
• Prepare denial determinations and coordinate approvals for cases exceeding delegated authority.
• Maintain detailed records of appeal research, negotiations, approvals, finalized agreements, and outcomes.
• Communicate appeal statuses and resolutions with clients and providers while managing cases in Zendesk, internal claims systems, Microsoft Outlook, and Microsoft Teams.

Requirements

• 2+ years of experience in healthcare claims, provider appeals, reimbursement, revenue cycle, or medical billing.
• Knowledge of CPT-4, HCPCS, Revenue Codes, DRG, and ICD-10 coding.
• Knowledge of the No Surprises Act, ERISA guidelines, Medicare reimbursement methodologies, and related legislation.
• Experience interpreting contracts and plan documents, reviewing EOBs, analyzing claim pricing, and identifying payment discrepancies.
• Experience with provider negotiations and counteroffers, plus proficiency in Microsoft Outlook, Teams, and Excel.
• Must be based in the United States and able to maintain a reliable work schedule in a secure remote environment.

Nice to have

• Associate or bachelor's degree in healthcare administration or a related field.
• CPC certification.
• Experience with international plans and self-funded insurance.
• Knowledge of the Independent Dispute Resolution process and related reimbursement guidelines.

Culture & Benefits

• Flexible fully remote work environment with company-provided equipment.
• Medical, dental, and vision insurance with company subsidies.
• HSA, FSA, and DCFSA spending account options.
• 401(k) with company match and immediate vesting.
• Paid vacation, sick leave, holidays, maternity leave, and paternity leave.
• Employee Assistance Program, pet insurance, discounts, and paid time off for philanthropic activities.