Clinical Appeals Senior Consultant

Vacancy NameClinical Appeals Senior Consultant CompanyCraneware Inc SpecialityCustomer Management CategoryPermanent Location Country Office LocationHome based - US Additional Locations Introduction to Craneware

Let's transform the business of healthcare! At The Craneware Group, we are dedicated to empowering our customers with industry-defining insights that pave the way for a brighter future.

If you are an energetic, forward-thinking individual with a passion for innovation, we invite you to join our thriving team of more than 750 dedicated professionals. Together, we''ll fuel the expansion of our SaaS platform and develop cutting-edge applications that redefine the healthcare landscape.

The Team

As a Clinical Appeals Senior Consultant, you serve as a strategic liaison between clinical and financial stakeholders, ensuring healthcare services are accurately documented, coded, billed, and reimbursed by leading clinical appeals, denial management, and chart audit initiatives.

You Will Be

• Managing assigned customer engagements from initiation through completion, ensuring timelines, deliverables, and budgets stay on track
• Designing and optimizing workflows by documenting current-state processes and implementing future-state solutions aligned to best practices
• Leading clinical appeals and denial management activities by reviewing denials, identifying root causes, and developing prevention strategies
• Evaluating clinical documentation, medical necessity, and payer guidelines to create evidence-based, defensible appeal strategies
• Producing high-quality appeal letters and presenting at hearings (e.g., ALJ) to support successful claim resolution
• Analyzing denial trends, audit findings, and operational data to provide actionable insights that reduce denials and improve performance
• Conducting detailed chart audits to assess documentation accuracy, coding alignment, and compliance with regulatory standards
• Partnering with customers as a trusted advisor, delivering education, coaching, and strategic guidance to improve documentation and workflows
• Collaborating cross-functionally with internal teams (product, sales, and services) to deliver a consistent, high-quality customer experience
• Ensuring compliance with HIPAA, payer requirements, and appeal deadlines while maintaining accurate documentation and data integrity

You Will Bring

• Active RN, BSN, or clinically relevant licensure required
• CCS or CPC certification required
• Minimum 7+ years of experience in appeals, denials management, chart auditing, or clinical documentation review
• Strong knowledge of medical necessity, payer policies, and revenue cycle operations
• Proven ability to manage customer-facing engagements and lead process improvement initiatives
• Exceptional written communication with ability to produce defensible clinical appeal documentation
• Strong analytical and problem-solving skills with focus on root cause identification
• Proficiency in EHR systems, clinical documentation tools, and revenue cycle platforms
• Ability to translate complex clinical and regulatory concepts into actionable insights
• Effective stakeholder engagement and relationship-building skills
• Travel up to 10%