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Clinical Resolution Analyst Jobs (NOW HIRING)

ApolloMD

Payer Dispute Analyst (57547)

Atlanta, GA · On-site

This role focuses heavily on the Independent Dispute Resolution (IDR) process under the No ... Collaborate with legal, revenue cycle, and clinical teams to support dispute strategies and ...

ApolloMD

Payer Dispute Analyst (57547)

Atlanta, GA · On-site

This role focuses heavily on the Independent Dispute Resolution (IDR) process under the No ... Collaborate with legal, revenue cycle, and clinical teams to support dispute strategies and ...

UnitedHealthcare

Clinical Claim Review | , |

The Sr. Recovery Resolution Analyst will conduct site visits and desk audits of provider claims ... Clinical or administrative experience in long term care, for example, nursing facility care ...

UnitedHealthcare At Home

Clinical Claim Review RN

The Sr. Recovery Resolution Analyst will conduct site visits and desk audits of provider claims ... Clinical or administrative experience in long term care, for example, nursing facility care ...

divvyDOSE

Clinical Claim Review RN

The Sr. Recovery Resolution Analyst will conduct site visits and desk audits of provider claims ... Clinical or administrative experience in long term care, for example, nursing facility care ...

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Job Title: Clinical Analyst Job Location: Remote Job Duration: Contract / FTE Client: Federal ... Case investigation / issue resolution * Excel and reporting * SOP/process documentation * Strong ...

Global Alliant Inc

Clinical Analyst

Baltimore, MD · On-site

Job Title: Clinical Analyst Job Location: Remote Job Duration: Contract / FTE Client: Federal ... Case investigation / issue resolution * Excel and reporting * SOP/process documentation * Strong ...

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Clinical Analyst JobLocation:Remote JobDuration: Contract / FTE Client: Federal Criteria-Need US ... Case investigation / issue resolution * Excel and reporting * SOP/process documentation * Strong ...

Clinical Ink

Validation Analyst

Company Information Clinical Ink is the global life science company that brings data, technology ... Documenting defects and tracking to resolution * Verifying approved study-specific configuration ...

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How much do clinical resolution analyst jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for clinical resolution analyst in the United States is $27.91, according to ZipRecruiter salary data. Most workers in this role earn between $23.08 and $34.13 per hour, depending on experience, location, and employer.

What is a clinical resolution analyst?

A Clinical Resolution Analyst is a healthcare professional who reviews, investigates, and resolves clinical issues or complaints, often related to healthcare claims, patient care, or provider services. They work closely with clinical teams, insurance companies, and patients to ensure accurate and efficient resolution of clinical concerns. Their responsibilities may include analyzing medical records, interpreting clinical guidelines, and communicating outcomes to stakeholders. This role requires strong analytical skills, attention to detail, and knowledge of healthcare regulations and terminology.

How does a clinical resolution analyst typically collaborate with healthcare providers and insurance teams to resolve patient cases?

A Clinical Resolution Analyst frequently acts as a liaison between healthcare providers, insurance teams, and patients to address complex clinical or billing issues. They review medical records, insurance claims, and provider notes to investigate discrepancies or denials, and then communicate findings and solutions to all parties involved. This collaborative process often involves regular meetings, detailed documentation, and coordination with clinical staff to ensure accurate and timely case resolution. Building strong relationships with both internal and external stakeholders is key to success in this role.

What are the key skills and qualifications needed to thrive as a clinical resolution analyst, and why are they important?

To thrive as a Clinical Resolution Analyst, you need a strong background in healthcare administration or clinical practice, analytical thinking, and problem-solving skills, often supported by a relevant degree or certification. Familiarity with electronic health records (EHR) systems, claims processing platforms, and healthcare compliance regulations is crucial. Excellent communication, attention to detail, and the ability to collaborate across departments are important soft skills for this role. These competencies ensure accurate case resolution, regulatory compliance, and effective communication between providers, payers, and patients.

What is the difference between Clinical Resolution Analyst vs Medical Claims Specialist?

AspectClinical Resolution AnalystMedical Claims Specialist
Required CredentialsHealthcare-related certifications, clinical knowledgeMedical billing/coding certifications, insurance knowledge
Work EnvironmentHealthcare facilities, insurance companiesMedical offices, insurance companies, billing centers
Employer & Industry UsageHospitals, healthcare providers, insurance firmsInsurance companies, healthcare billing services
Common Search & ComparisonYesNo

The Clinical Resolution Analyst primarily focuses on resolving clinical and patient-related issues, often requiring healthcare knowledge and clinical certifications. In contrast, a Medical Claims Specialist handles billing, coding, and claims processing. While both roles work within healthcare and insurance environments, their core responsibilities differ, making this comparison relevant for those exploring healthcare support careers.

What cities are hiring for Clinical Resolution Analyst jobs?

Cities with the most Clinical Resolution Analyst job openings:

What states have the most Clinical Resolution Analyst jobs?

States with the most job openings for Clinical Resolution Analyst jobs include:

Clinical Resolution Analyst jobs near you

Payer Dispute Analyst (57547)

ApolloMD

Atlanta, GA • On-site

Full-time

Posted 21 days ago

Job description

About ApolloMD
ApolloMD partners with more than 100 hospitals nationwide to provide integrated, multispecialty physician, APC and practice management services in Emergency Medicine, Hospital Medicine, Anesthesia, and Revenue Cycle Management. Our high touch, solution-based approach emphasizes quality, efficiency, communication and patient experience. ApolloMD works collaboratively with partner facilities to implement best practices and process improvement across the board in a cost-effective manner. Learn more about our growing team at apollomd.com.
Position Summary
The Payer Dispute Analyst supports the organization's efforts to resolve disputes with payers. This role focuses heavily on the Independent Dispute Resolution (IDR) process under the No Surprises Act and state dispute resolution processes, while maintaining flexibility to handle additional payer dispute matters and processes as needed. The Analyst will review and analyze claims for reimbursement and work collaboratively with internal teams and external entities to secure appropriate reimbursement.
Key Responsibilities
  • Review, analyze, and interpret claims data to ensure accurate payment in alignment with applicable policies and regulatory requirements.
  • Research and prepare reports identifying trends, recurring issues, and high-level reimbursement concerns.
  • Manage designated aspects of the No Surprises Act IDR and state dispute resolution processes, from case initiation through final payer determination.
  • Prepare and submit Final Offers through the CMS portal, ensuring accuracy and strict adherence to regulatory deadlines.
  • Oversee the resolution process for claims in dispute, including documentation, submission, and follow-up to ensure proper reimbursement.
  • Compile and organize supporting materials including Position Statements (Briefs), Good Faith Negotiation documents, and relevant clinical documentation.
  • Track submission timelines and proactively manage deadlines to ensure timely case processing.
  • Maintain comprehensive, audit-ready records of all dispute submissions and outcomes.
  • Collaborate with legal, revenue cycle, and clinical teams to support dispute strategies and documentation needs.
  • Maintain up-to-date knowledge of payer policies, state/federal regulations, and industry best practices related to dispute resolution.
  • Assist in developing process improvements to enhance efficiency, accuracy, and compliance.
  • Support special projects and other duties as assigned to meet departmental and organizational objectives.

Qualifications
Required
  • 2+ years of experience in healthcare claims, payer disputes, or revenue cycle.
  • Strong organizational skills with the ability to manage multiple priorities in a high-volume, fast-paced environment.
  • Excellent verbal and written communication skills.
  • Proactive, team-oriented mindset with a high degree of professionalism.
  • Strong problem-solving and analytical abilities.
  • Proficiency in Microsoft Excel and other Microsoft Office applications.
  • High School Diploma or equivalent required; Bachelor's degree preferred.

Preferred
  • Working knowledge of the No Surprises Act and federal IDR processes.
  • Experience with accounts receivable, payer disputes, or legal disputes.
  • Familiarity with the Athena billing system.
  • Experience with state dispute resolution processes or similar payer dispute workflows.
  • Background in medical billing, claims processing, or payer-provider dispute resolution.

Core Competencies
  • Exceptional attention to detail and organizational discipline.
  • Ability to manage competing priorities and strict regulatory deadlines.
  • Genuine interest in healthcare policy, revenue cycle, or compliance.
  • Strong cross-functional collaboration and communication skills.
  • Analytical mindset with the ability to review and interpret complex claims data.

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