Clinical Analyst - Appeals (LPN or RN License Required)

Job Description

Job Title:

Clinical Analyst – Appeals (LPN or RN License Required)

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Location:

Hybrid (First 3 months of training) | Remote thereafter

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Company Overview:

At Healthcare Retroactive Audits, Inc. (HRA), we specialize in uncovering missed revenue opportunities for hospitals through meticulous reviews of underpaid or denied claims. We are committed to advocating for appropriate reimbursement and improving the financial health of our healthcare partners—all while maintaining a positive, collaborative work culture.

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Position Summary:

We are seeking an experienced Clinical Analyst with a strong background in hospital-based appeals, medical record review, and denial analysis. This role is ideal for a licensed nurse ready to transition from direct patient care into a meaningful, remote-based opportunity where clinical knowledge is used to advocate for care decisions and financial recovery.

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🛠 Key Responsibilities:

· Review medical records and payer correspondence to determine the merit of an appeal

· Write clear, persuasive appeal letters based on clinical documentation and payer guidelines (e.g., CMS, InterQual, MCG)

· Analyze payer denials and identify trends across payers, departments, or service lines

· Collaborate with internal auditors, appeal teams, and clinical leadership to improve documentation and reduce denial rates

· Maintain up-to-date knowledge of industry regulations, payer policies, and appeal timelines

· Ensure appeal submissions meet quality, compliance, and timeliness standards

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Qualifications:

· Registered Nurse (RN) or Licensed Practical Nurse (LPN); active and unencumbered license required

· Minimum 2 years of clinical experience in a hospital setting (inpatient, utilization review, case management, or similar)

· Prior experience reviewing medical records and writing clinical appeals strongly preferred

· Familiarity with payor guidelines, coding (ICD-10, CPT), and electronic health records (EHR)

· Strong writing, analytical, and time management skills

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Ideal Candidate:

· A former hospital nurse looking to apply clinical knowledge in a remote, non-clinical role

· Detail-oriented and skilled in written communication

· Comfortable working independently in a fast-paced, deadline-driven environment

· Passionate about advocating for proper reimbursement and improving documentation practices

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Compensation:

Salary: Open, based on experience and qualifications Benefits: Competitive benefits package including health, dental, vision, paid time off, and professional development support

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Work Structure:

· Hybrid for the first 3 months of training (South Florida-based candidates preferred)

· Fully remote thereafter

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How to Apply:

Submit your resume and a brief cover letter describing your clinical background and interest in transitioning to an appeals role.