Appeals Analyst

Cynet Systems • West Sacramento, CA

1d

About The Position

The Appeals Analyst reviews, investigates, and processes provider appeals related to healthcare claims, denials, payment discrepancies, and reimbursement decisions. The role ensures appeal resolutions are accurate, timely, and compliant. The analyst reviews claims and supporting records, interprets applicable Medi-Cal/Medicaid policies and departmental procedures, documents determinations, and escalates complex or recurring issues.

Requirements

• At least 3 years of experience in healthcare appeals and grievances, preferably involving Medi-Cal/Medicaid.
• Experience with provider appeals, denied claims, claim adjustments, payment disputes, or claims reconsiderations.
• Strong analytical, research, and problem-solving skills.
• Ability to interpret healthcare claims policies and supporting documentation.
• Excellent attention to detail, accuracy, and written communication.
• Ability to manage multiple cases and meet turnaround-time requirements.

Nice To Haves

• Previous claims processing or claims adjudication experience.

Responsibilities

• Review and process provider appeals involving denied, underpaid, or disputed healthcare claims.
• Investigate claim history, payment records, denial reasons, and supporting documentation.
• Interpret Medi-Cal/Medicaid policies, claims guidelines, and departmental procedures.
• Research claim discrepancies and payment issues.
• Prepare accurate case notes, appeal determinations, and supporting documentation.
• Meet turnaround times, productivity targets, and quality standards.
• Identify recurring claim issues and escalate complex cases.
• Maintain compliance with applicable policies and procedures.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed