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Appeals Auditor Jobs (NOW HIRING)

Cotiviti

Senior Auditor Appeals - OPSP

$82K - $101K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Overview The Senior Auditor, Appeals position is part of the Clinical Chart Validation (CCV) team and is responsible for defending Cotiviti's recovery determinations utilizing the appropriate ...

Cotiviti

Senior Auditor Appeals - OPSP

$82K - $101K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Overview The Senior Auditor, Appeals position is part of the Clinical Chart Validation (CCV) team and is responsible for defending Cotiviti's recovery determinations utilizing the appropriate ...

Covenant Health

INSURANCE APPEALS ASSOC

Knoxville, TN · On-site

Provides feedback to Revenue Integrity Auditors and Patient Account Representatives as it relates to department operations. Responsibilities * Analyze denials and coordinates insurance appeals.

Independence Blue Cross

Supervisor Appeals

Philadelphia, PA · On-site

$22.25 - $27.50/hr

Compliance, Auditing & Quality Assurance * Conducts regular audits of closed appeals files to confirm compliance with state requirements, NCQA standards, and internal processes; identifies root ...

Independence Blue Cross

Supervisor Appeals

Philadelphia, PA · On-site

$22.25 - $27.50/hr

Compliance, Auditing & Quality Assurance * Conducts regular audits of closed appeals files to confirm compliance with state requirements, NCQA standards, and internal processes; identifies root ...

UHS

APPEALS SPECIALIST

Las Vegas, NV · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

... Auditors to support medical necessity appeals. This position requires preparing and submitting accurate appeal documentation, conducting thorough research to gather supporting evidence, and ensuring ...

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Appeals Auditor information

See salary details

$33K

$76.3K

$121.5K

How much do appeals auditor jobs pay per year?

As of Aug 18, 2026, the average yearly pay for appeals auditor in the United States is $76,256.00, according to ZipRecruiter salary data. Most workers in this role earn between $53,500.00 and $98,500.00 per year, depending on experience, location, and employer.

What is an appeals auditor?

Appeals Auditors are professionals who review and evaluate appeals related to insurance claims, healthcare billing, or other administrative decisions. They examine documentation, verify compliance with relevant regulations and policies, and determine whether the original decision should be upheld or overturned. Appeals Auditors play a crucial role in ensuring fairness and accuracy in the appeals process, often working for insurance companies, healthcare providers, or government agencies. Their work helps maintain integrity and trust in organizational procedures.

What are the key skills and qualifications needed to thrive as an appeals auditor, and why are they important?

To thrive as an Appeals Auditor, you need a strong understanding of healthcare regulations, claims processing, and auditing principles, often supported by a degree in healthcare administration or a related field. Proficiency with claims management software, EHR systems, and familiarity with HIPAA and CMS guidelines are typically required. Analytical thinking, attention to detail, and effective communication are essential soft skills for reviewing complex cases and collaborating with stakeholders. These skills ensure accurate and compliant appeals processing, minimizing financial risk and supporting organizational integrity.

What are some common challenges appeals auditors face when reviewing complex cases, and how can they overcome them?

Appeals Auditors often encounter challenges such as interpreting ambiguous documentation, ensuring compliance with rapidly changing regulations, and balancing accuracy with efficiency under tight deadlines. To overcome these hurdles, auditors typically rely on thorough training, regular updates on industry guidelines, and collaboration with subject matter experts or legal teams. Effective communication and attention to detail are essential, as is staying organized to manage multiple cases simultaneously. Proactively seeking clarification and participating in team discussions can also help resolve uncertainties and improve the quality of audits.

What is the difference between Appeals Auditor vs Claims Processor?

CriteriaAppeals AuditorClaims Processor
Required credentialsTypically requires auditing, accounting, or claims processing certificationsUsually needs claims processing or insurance-related certifications
Work environmentAuditing departments, insurance companies, or healthcare organizationsClaims departments within insurance companies or healthcare providers
Employer and industry usageUsed in insurance, healthcare, and government agencies for compliance and accuracyCommonly employed in insurance companies handling claim submissions and payments
Search and comparison intentOften compared for roles involving review and compliance of claimsCompared for roles focused on processing and managing claims

While both Appeals Auditors and Claims Processors work within the insurance and healthcare industries, Appeals Auditors primarily review and verify the accuracy of claims during appeals, ensuring compliance and correctness. Claims Processors handle the initial processing of claims, focusing on data entry and payment. Understanding these differences helps job seekers identify roles aligned with their skills and career goals.

More about Appeals Auditor jobs

What cities are hiring for Appeals Auditor jobs?

Cities with the most Appeals Auditor job openings:

What states have the most Appeals Auditor jobs?

States with the most job openings for Appeals Auditor jobs include:

What job categories do people searching Appeals Auditor jobs look for?

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Appeals Auditor jobs near you
Infographic showing various Appeals Auditor job openings in the United States as of August 2026, with employment types broken down into 89% Full Time, 8% Part Time, 2% Contract, and 1% Nights. Highlights an 88% Physical, 5% Hybrid, and 7% Remote job distribution, with an average salary of $76,256 per year, or $36.7 per hour.

Senior Auditor Appeals - OPSP

Cotiviti

Remote

$82K - $101K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago

Cotiviti rating

8.3

Company rating: 8.3 out of 10

Based on 33 frontline employees who took The Breakroom Quiz

51st of 224 rated it services

Job description

Overview
The Senior Auditor, Appeals position is part of the Clinical Chart Validation (CCV) team and is responsible for defending Cotiviti's recovery determinations utilizing the appropriate guidelines including but not limited to Commercial, CMS inpatient and outpatient coding guidelines, coding clinics, and internal clinical validation policies if applicable. The appeals auditor is responsible for performing an extensive review of the initial claim along with the associated documentation as well as any additional information submitted by the provider on appeal. The appeals auditor will render a decision, and formulate a written response, on each claim reviewed providing the most accurate decision possible. The appeals auditor assists the team leads in providing any educational feedback appropriate for the initial audit team and QA. This person is considered a Subject Matter Expert in all CCV review types and appeals. Displays professional skepticism that enhances the work performed in order to achieve success the role position.
Responsibilities
  • Utilizes all available tools and resources to evaluate each appeal reviewed.
  • Applies the policies and guidelines appropriate to the claim/appeal to deliver the most accurate decision.
  • Constructs factual, reference-supported responses to the provider describing reasons for the determination.
  • Constructs grammatically correct, claim-specific, and professionally written responses to the providers.
  • Ensures that service level agreements are met for any work assigned.
  • Maintains a minimum productivity standard as outlined for the role.
  • May flex into the role of the QA auditor or the initial auditor as business needs require.
  • Provides educational feedback to the audit and QA team based upon appeal reviews.
  • Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.
Qualifications
  • Education (at least one of the following is required)-
    • Associates or Bachelor's degree in Nursing (active/unrestricted license).
    • Associate or Bachelor's degree in Health Information Management (RHIA or RHIT).
    • Equivalent experience of 5+ years experience in claims auditing, quality assurance, or recovery auditing...ideally in a DRG / Clinical Validation Audit setting or a hospital environment.
  • Coding Certification (at least one of the following are required and are to be maintained as a condition of employment)-
    • RHIA or RHIT.
    • Inpatient Coding Credential - CCS or CIC preferred.
    • Candidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification within 1 year of their hire date with the company.
  • Experience (required)-
    • 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
    • 3-5 years of medical record auditing or similar experience.
    • Ability to utilize and analyze clinical auditing knowledge and skills to learn and become proficient in a variety of review types such as DRG, SNF, Home Health, DME, Hospice, Readmissions, SS, and therapy reviews.
    • Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes.
    • Requires working knowledge of and applicable industry-based standards.
    • Proficiency in Word, Access, Excel, and other applications.
    • Excellent written and verbal communication skills.
    • Ability to work well in an individual and team environment.

Work Environment:
  • This is an at home-based position and you must have a work location within the continental US.
  • This position requires that you provide a high speed internet connection and a work environment free from distractions.
  • This role is aligned to certain productivity and quality requirements.

Mental Requirements:
  • Communicating with others to exchange information.
  • Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:
  • Remaining in a stationary position, often standing or sitting for prolonged periods.
  • Repeating motions that may include the wrists, hands, and/or fingers.
  • Must be able to provide a dedicated, secure work area.
  • Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
  • No adverse environmental conditions expected.

Starting salary for this position is 101k (48.56/hour). Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.
Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
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