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Remote Appeals Representative Jobs (NOW HIRING)

Evergreen Health

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

... Remote in Washington State only Posted wage ranges represent the entire range from minimum to ... Responsible for the review, appeal strategy, resolution and reporting of payer claim denials to ...

EvergreenHealth

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

... Remote in Washington State only Posted wage ranges represent the entire range from minimum to ... Responsible for the review, appeal strategy, resolution and reporting of payer claim denials to ...

Addison Group

Patient Account Representative

Frisco, TX · Remote

$18 - $20/hr

Fully Remote (Must reside in an approved state) Schedule: Flexible Scheduling Available Benefits ... Work appeals and identify resolution opportunities for reimbursement issues. * Review and interpret ...

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Remote Prior Authorization Rep

Atlanta, GA · Remote

$20/hr

Initiate and follow up on prior authorizations, step therapy reviews, and appeals as applicable ... REMOTE WORK REQUIREMENTS * Position is fully remote and open to U.S. residents. * Must have a ...

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Remote Appeals Representative information

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How much do remote appeals representative jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for remote appeals representative in the United States is $24.55, according to ZipRecruiter salary data. Most workers in this role earn between $14.90 and $28.85 per hour, depending on experience, location, and employer.

What does a remote appeals representative do?

A Remote Appeals Representative reviews and processes appeals from customers, often related to insurance claims, billing disputes, or service denials. They work from a remote location, communicating with clients, healthcare providers, or other stakeholders to gather necessary information and documentation. Their primary role is to assess the validity of appeals, ensure compliance with company policies and regulations, and provide clear resolutions. Attention to detail, strong communication skills, and knowledge of relevant laws and procedures are essential for this job.

What are the key skills and qualifications needed to thrive as a remote appeals representative?

To thrive as a Remote Appeals Representative, you need a solid understanding of healthcare policies, claims processing, and insurance guidelines, often supported by experience in medical billing or a related field. Familiarity with claims management software, electronic health records (EHRs), and proficiency in Microsoft Office Suite are typically required. Exceptional attention to detail, strong written communication, and problem-solving skills help individuals excel in this role. These abilities are crucial for accurately reviewing, processing, and resolving appeals while ensuring compliance and member satisfaction.

How does a remote appeals representative typically collaborate with other departments to resolve complex cases?

As a Remote Appeals Representative, you will frequently interact with departments such as claims processing, medical review, and customer service to gather necessary information and clarify case details. Collaboration often involves virtual meetings, secure messaging, and shared documentation platforms to ensure all stakeholders are aligned and have access to relevant data. This cross-functional teamwork is essential for resolving complex or escalated appeals efficiently while maintaining compliance with company and regulatory standards.

What is the difference between Remote Appeals Representative vs Remote Customer Service Representative?

AspectRemote Appeals RepresentativeRemote Customer Service Representative
Required CredentialsHigh school diploma or equivalent; some roles may require knowledge of appeals processesHigh school diploma or equivalent; customer service experience often preferred
Work EnvironmentHome-based, handling appeals cases for insurance, healthcare, or government agenciesHome-based, assisting customers with inquiries, billing, and product support
Employer & IndustryInsurance companies, healthcare providers, government agenciesRetail, telecommunications, service providers
Common Search & ComparisonAppeals process, claims review, dispute resolutionCustomer support, help desk, client assistance

The Remote Appeals Representative focuses on reviewing and resolving appeals related to claims or benefits, requiring specific knowledge of appeals procedures. In contrast, the Remote Customer Service Representative handles general customer inquiries and support. Both roles are remote, but they serve different functions within their industries.

What cities are hiring for Remote Appeals Representative jobs?

Cities with the most Remote Appeals Representative job openings:

What are the most commonly searched types of Appeals Representative jobs?

The most popular types of Appeals Representative jobs are:

What states have the most Remote Appeals Representative jobs?

States with the most job openings for Remote Appeals Representative jobs include:

Remote Appeals Representative jobs near you

Clinical Denials Nurse-Appeals (Remote)

ScionHealth

Lewiston, ID • On-site, Remote

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

ScionHealth rating

5.6

Company rating: 5.6 out of 10

Based on 49 frontline employees who took The Breakroom Quiz

807th of 898 rated healthcare providers

Job description

Join St. Joseph Regional Medical Center in Lewiston, Idaho-where nationally recognized quality meets small-town heart. We're proud to be recognized for excellence and patient safety, including an "A" Hospital Safety Grade from The Leapfrog Group, inclusion in Becker's list of "Great Community Hospitals," and U.S. News & World Report accolades for maternity care.
Here, you'll find a teamwork-first culture, leaders who support you, and coworkers who genuinely have your back. New grads are welcome-we're committed to training, mentoring, and helping you build confidence as you grow. And because we know great care starts with taking care of our people, we offer competitive benefits and a workplace you can feel good about.
If you're looking for a place to do meaningful work, build a career, and feel proud serving your community-you belong at St. Joe's.
Job Summary
The Clinical Denial Appeals Coordinator supports the Revenue Cycle by assessing and utilizing clinical and financial information to obtain optimal reimbursement and assure maximum appropriate payment for the organization. This role partners with patients, physicians, case managers, payers, and other healthcare providers to resolve denials, underpayments, reconsiderations, and appeals. The coordinator identifies trends, educates staff, and contributes to process improvement efforts to minimize denials and optimize resource utilization. This position requires flexibility, strong communication skills, and the ability to represent the organization effectively during appeals and hearings.
Essential Functions
  • Assess clinical and financial information concurrently and retrospectively to evaluate medical necessity, level of care, and coverage issues.
  • Participate in telephone clinical reviews and multidisciplinary discussions regarding patient care coverage.
  • Collaborate with hospital case managers, payers, and reviewers to resolve managed care issues, denials, and appeals.
  • Educate hospital staff, case managers, and coders regarding managed care and coding-related denial issues.
  • Interact with payer representatives to resolve denial reasons and secure reimbursement.
  • Represent the organization in hearings and coordinate representation as appropriate.
  • Identify denial trends and refer to appropriate agencies or resources for further action.
  • Contribute to process improvement initiatives to reduce denials and improve reimbursement outcomes.
  • Complete all required documentation accurately and timely.
  • Maintain confidentiality of patient and organizational information.

Knowledge/Skills/Abilities/Expectations
  • Strong knowledge of patient billing operations, UB-04, itemized statements, and coding processes.
  • Familiarity with denial reasons (medical necessity, technical, financial) and effective resolution strategies.
  • Demonstrated understanding of Medicaid, Medicare, commercial insurance, and managed care plans (HMO/PPO).
  • Effective verbal and written communication skills.
  • Ability to work collaboratively across disciplines and with external organizations.
  • Commitment to continuous process improvement.
  • Prolonged periods of sitting and working at a computer.
  • Occasional standing, walking, and light lifting up to 15 pounds.
  • Requires visual acuity to review detailed claim and medical record information.
  • Standard office environment within hospital or centralized business office setting.
  • Regular interaction with hospital staff, payers, and external agencies.
  • Requires ability to manage multiple priorities in a fast-paced environment.

Qualifications
Education
  • Minimum: Licensed Practical Nurse (LPN) or three (3) years of clinical denial experience.
  • Preferred: Degree in Nursing or Coding Certificate.

Licenses/Certifications
  • Relevant clinical or coding certification preferred.

Experience
  • Minimum of three (3) years of LPN, clinical denial management or related healthcare revenue cycle functions.
  • Experience in working with insurance plans, denials, reconsiderations, and appeals preferred.
  • Preferred experience in nursing, case management, or health information management.

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