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Provider Appeals Jobs (NOW HIRING)

MedImpact

Appeals Clinical Specialist

San Diego, CA · On-site +1

$73.30 - $94.43/hr

We provide superior outcomes to those we serve through innovative products, systems, and services ... Summary The Appeals team oversees all operational and clinical aspects of the appeals process ...

MedImpact

Appeals Clinical Specialist

San Diego, CA

$73.30 - $94.43/hr

We provide superior outcomes to those we serve through innovative products, systems, and services ... Summary The Appeals team oversees all operational and clinical aspects of the appeals process ...

Ethos Risk Services

Bill Review Specialist

CA · On-site

$22 - $28/hr

Research Provider Appeals - Investigate provider appeals, reconsiderations, and billing disputes by interpreting applicable fee schedules, reimbursement methodologies, regulations, and client ...

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Provider Appeals information

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How much do provider appeals jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for provider appeals in the United States is $28.06, according to ZipRecruiter salary data. Most workers in this role earn between $15.62 and $35.10 per hour, depending on experience, location, and employer.

What are some common challenges faced in a provider appeals role, and how can candidates prepare to address them?

Professionals in Provider Appeals often encounter complex cases requiring thorough knowledge of payer policies, medical necessity, and regulatory guidelines. Navigating tight deadlines, managing multiple appeals simultaneously, and communicating effectively with providers and insurers are frequent challenges. Candidates can prepare by developing strong organizational skills, staying current on healthcare regulations, and practicing clear, concise written communication. Building relationships with cross-functional teams, such as clinical staff and claims processors, also helps resolve issues efficiently.

What are the key skills and qualifications needed to thrive as a provider appeals specialist, and why are they important?

To thrive as a Provider Appeals Specialist, you need a strong understanding of healthcare claims processing, insurance guidelines, and regulatory compliance, often supported by experience in medical billing or health administration. Familiarity with claims management systems, medical coding software (such as ICD-10 and CPT), and electronic health record platforms is typically required. Attention to detail, analytical thinking, and effective written and verbal communication are crucial soft skills for evaluating appeals and advocating for providers. These abilities ensure accurate, timely resolution of appeals, compliance with regulations, and positive relationships between healthcare providers and payers.

What are provider appeals?

Provider appeals are formal requests made by healthcare providers to insurance companies or payers to review and reconsider a denied or reduced claim for reimbursement. When a claim is denied, providers can submit an appeal to challenge the decision, often including additional documentation or explanations to support their case. The appeals process is an essential part of healthcare administration, helping ensure that providers receive fair payment for services rendered. Understanding the reasons for denials and following the payer's specific appeal procedures is critical for successful outcomes.
What are the most commonly searched types of Provider Appeals jobs? The most popular types of Provider Appeals jobs are:
What job categories do people searching Provider Appeals jobs look for? The top searched job categories for Provider Appeals jobs are:
Provider Appeals jobs near you
Infographic showing various Provider Appeals job openings in the United States as of August 2026, with employment types broken down into 71% Full Time, 6% Part Time, 6% Temporary, and 17% Contract. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $58,373 per year, or $28.1 per hour.

Z TEMP - Grievance Resolution Specialist (Provider Resolution)

Partners in Diversity

Orange, CA • On-site

$25.87 - $38.80/hr

Temporary

Posted 29 days ago

Job description

Job Title: Z TEMP - Grievance Resolution Specialist (Provider Resolution)
Position Information:
  • Department: Grievance & Appeals
  • Compensation: $25.87 - $38.80 DOE
  • Work Arrangement: Full Office
  • Work Schedule: Monday through Friday; 8:00 a.m. to 5:00 p.m.
  • Expected Assignment Duration: up to six (6) months
Duties & Responsibilities:
  • 90% - Program Support
    • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
    • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
    • Maintains adequate information in Health’s systems and ensures data collection, summarization, integration and reporting, which includes case creation and management and events/activity tracking.
    • Gathers pertinent information regarding the grievances and appeals received, including member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal or supplemental information required to evaluate grievances and appeals within regulatory requirements.
    • Coordinates and participates in case discussions with operational experts to result in a final case disposition as needed.
    • Evaluates case details, proposes recommendations or makes decisions as applicable and ensures the organization’s decision is implemented according to the Grievance and Appeals policies and case resolution.
    • Develops resolution letters and correspondence to members and providers.
    • Communicates with internal and external customers to ensure timely review and resolution of grievances or appeals.
    • Contacts appropriate parties to request and obtain missing information and supporting documentation or provides education.
    • Reads and interprets provider contracts, Division of Financial Responsibility (DOFR), policies, procedures and instructions.
    • Responds to routine provider inquiries via phone, assisting with provider appeals resolution inquiries.
    • Assists with the health networks’ compliance process.
    • Identifies trends and root causes of issues, proposes solutions or escalates ongoing issues to management.
    • Meets performance measurement goals for Grievance and Appeals Resolution Services.
  • 10% - Other
    • Completes other projects and duties as assigned.
Minimum Qualifications:
  • High school diploma or equivalent PLUS 1 year of experience with Provider Dispute Resolution in Medicare and Medi-Cal in professional, institutional, outpatient, ancillary, coordination of benefits and government cases required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
  • 1 year of experience with Medicare or Medi-Cal provider appeals and denials process required.
  • 1 year of experience in any of the following areas: Grievances and Appeals, Claims Administration, Regulatory Compliance, Customer Service or related field required.
Preferred Qualifications:
  • Associate degree in business, health care administration or related field.
  • Experience in health care practice standards, for both government and commercial plans.
  • Bilingual in English and in one of Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
Knowledge & Abilities:
  • Develop rapport and establish and maintain effective working relationships with Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
  • Work independently and exercise sound judgment.
  • Communicate clearly and concisely, both orally and in writing.
  • Work a flexible schedule; available to participate in evening and weekend events.
  • Organize, be analytical, problem-solve and possess project management skills.
  • Work in a fast-paced environment and in an efficient manner.
  • Manage multiple projects and identify opportunities for internal and external collaboration.
  • Motivate and lead multi-program teams and external committees/coalitions.
  • Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Physical Requirements (With or Without Accommodations):
  • Ability to visually read information from computer screens, forms and other printed materials and information.
  • Ability to speak (enunciate) clearly in conversation and general communication.
  • Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
  • Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
  • Lifting and moving objects, patients and/or equipment 10 to 25 pounds