Mid Level Clinical Analyst Jobs
Mid level clinical analyst jobs go to professionals ready to own projects end to end, drive data-driven decisions with limited oversight, and mentor junior team members across clinical and operational workflows. About 44% of openings mix remote and on-site work across Healthcare & Medical Services, Education, and Insurance, with employers like Excellus BCBS, Novant Health, and HonorHealth hiring at this level now.
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Position Summary
The Clinical Appeals Analyst at Riverside Healthcare is responsible for managing and processing clinical appeals and denials for various payers. This role requires a deep understanding of clinical documentation, medical necessity criteria, and payer policies to develop and submit compelling appeal cases. The Clinical Appeals Analyst works closely with medical providers, revenue cycle teams, and insurance representatives to ensure the appropriate reimbursement for healthcare services. The role involves reviewing denied claims, conducting root cause analysis, and crafting appeal letters that effectively present clinical arguments to support the medical necessity of care.
Essential Job Duties
- Review and analyze denied claims to determine the basis for denial and the potential for successful appeal.
- Draft and submit clinical appeals to payers, utilizing medical records, clinical documentation, and medical necessity criteria to support the appeal.
- Collaborate with medical providers, coding specialists, CDI, and revenue cycle team to gather necessary documentation for clinical appeals.
- Perform root cause analysis of denied claims to identify trends and opportunities for process improvement.
- Monitor the status of submitted appeals and ensure timely follow-up with payers for resolution.
- Maintain a detailed log of appeals activity, including outcomes and any necessary follow-up actions.
- Stay up-to-date with payer policies, reimbursement guidelines, and regulatory changes that may impact the appeals process.
- Work with insurance representatives to resolve escalated issues and negotiate settlements as necessary.
- Develop reports and presentations on appeals activity and outcomes for leadership and relevant stakeholders.
- Perform analysis on refund requests for inpatient clinical accounts.
Nonessential Tasks
- Participate in training sessions to educate clinical and administrative staff on common causes of denials and best practices for preventing them.
- Support the revenue cycle team with special projects related to claim denials, clinical criteria, and reimbursement improvement.
- Assist in the development of process improvements aimed at reducing denial rates.
Required Education and License/Qualifications
- Bachelors degree in Nursing, Healthcare Administration, or a related field required.
- 3+ years of experience in clinical appeals, utilization management, or revenue cycle operations within a healthcare setting.
- Strong knowledge of payer policies, medical necessity criteria, and healthcare reimbursement processes.
- Excellent analytical, organizational, and problem-solving skills.
- Strong written and verbal communication skills, with the ability to craft persuasive appeal letters.
- Proficiency in using appeals management software and electronic health records systems (Epic preferred).
- Ability to work independently, prioritize tasks effectively, and maintain attention to detail in a fast-paced environment.
Certification Requirement
- RN or clinical certification preferred.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Our Commitment To You
Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes:
Compensation
- Base compensation within the positions pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift differential, on-call
- Opportunity for annual increases based on performance
Benefits - .5 To 1.0 FTE
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
Benefits - .001 To .49 FTE
- Paid Leave Hours accrued as you work
Employee Health Requirements
Exposure/Sensory Requirements
Exposure To
- Chemicals: Refer to MSDS manual
- Video Display Terminals: Average
- Blood and Body Fluids: Diagnostic composite of patients, frequent contact with intravenous devices, and high potential for contact with contaminated body fluids (blood, vomitus, stool) and administration of blood does create a high risk. Use of needleless IV system, universal precautions and protective equipment minimize risk.
- TB or Airborne Pathogens: Patient diagnostic presentations do pose high risk. Usage of protective wear and universal precautions minimize risk.
Sensory Requirements (speech, Vision, Smell, Hearing, Touch)
- Speech: Required to communicate with patient/families/staff/doctors, coworkers, ancillary personnel and other department heads. Ability to ask for help.
- Vision: Required to perform necessary assessments of patient status, medication administration, CIS usage, and reading active orders and lab reports.
- Smell: Helpful to note presence of incontinence, vomitus, blood; electrical/fire safety.
- Hearing: Necessary to hear alarms, calls for help and to hear patient verbalizations. Necessary to hear lung, bowel and heart sounds. Needed to hear alarms (i.e., fire, codes via PA system).
- Touch: Necessary to perform percussive assessments and to comfort patients. Also needed to manipulate tools and equipment.
Activity/Lifting Requirements
Percentage of time during the normal workday the employee is required to:
- Sit: 10%
- Twist: 4%
- Stand: 40%
- Crawl: 0%
- Walk: 25%
- Kneel: 1%
- Lift: 10%
- Drive: 0%
- Squat: 1%
- Climb: 1%
- Bend: 30%
- Reach above shoulders: 3%
The weight required to be lifted each normal workday according to the continuum described below:
- Up to 10 lbs: Frequently
- Up to 20 lbs: Frequently
- Up to 35 lbs: Frequently
- Up to 60 lbs: Occasionally
- Up to 75 lbs: Not Required
- Up to 100 lbs: Not Required
- Over 100 lbs: Not Required
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting patients off their beds that are unable to move independently is done with assistive lifting equipment. Horizontal movement of patients to and from carts/beds who are unable to move independently is done with assistive lifting equipment. Lifting equipment - carry 25'- 150' waist high (IV bags, patient trays, charts). Filled laundry bags are filled half full so as not to weigh over 35#. Carry fire extinguishers up/down 3-4 flights of stairs and several yards in emergency.
Maximum consecutive time (minutes) during the normal workday for each activity:
- Sit: 30
- Twist: 15
- Stand: 60
- Crawl: 0
- Walk: 10
- Kneel: 0
- Lift: 5
- Drive: 0
- Squat: 2
- Climb: 1
- Bend: 15
- Reach above shoulders: 2
Repetitive Use Of Hands (Frequency Indicated)
- Simple grasp up to 10# Normal weight:
- Pushing & pulling - 50-200#: Occasionally
- Fine Manipulation: Typing in computer, omnicell, using pens to chart, drawing up meds in syringe and administration, starting IV's. Leg Strength - up to 50#: Occasionally- (repetitive use of foot or feet in operating machine control: utilized in positioning beds during transport; x-ray, surgery or in an emergency situation from floor to floor, locking beds or cardiac chairs.)
Environmental Factors & Special Hazards
- Environmental Factors (Time Spent):
- Inside hours: 12
- Outside hours: 0
- Temperature: Normal Range
- Lighting: Average
- Noise levels: Average
- Humidity: Normal Range
- Atmosphere: Odors
- Special Hazards: Radiation, Chemical, Explosive - Chemical-drugs; Explosive-oxygen; Radiation cesium implants and radioactive iodine therapy.
- Protective Clothing Required: Gowns, gloves, goggles, masks, HEPA masks for TB.
Pay Range
USD $31.40 - USD $41.21 /Hr
Position Summary
The Clinical Appeals Analyst at Riverside Healthcare is responsible for managing and processing clinical appeals and denials for various payers. This role requires a deep understanding of clinical documentation, medical necessity criteria, and payer policies to develop and submit compelling appeal cases. The Clinical Appeals Analyst works closely with medical providers, revenue cycle teams, and insurance representatives to ensure the appropriate reimbursement for healthcare services. The role involves reviewing denied claims, conducting root cause analysis, and crafting appeal letters that effectively present clinical arguments to support the medical necessity of care.
Essential Job Duties
- Review and analyze denied claims to determine the basis for denial and the potential for successful appeal.
- Draft and submit clinical appeals to payers, utilizing medical records, clinical documentation, and medical necessity criteria to support the appeal.
- Collaborate with medical providers, coding specialists, CDI, and revenue cycle team to gather necessary documentation for clinical appeals.
- Perform root cause analysis of denied claims to identify trends and opportunities for process improvement.
- Monitor the status of submitted appeals and ensure timely follow-up with payers for resolution.
- Maintain a detailed log of appeals activity, including outcomes and any necessary follow-up actions.
- Stay up-to-date with payer policies, reimbursement guidelines, and regulatory changes that may impact the appeals process.
- Work with insurance representatives to resolve escalated issues and negotiate settlements as necessary.
- Develop reports and presentations on appeals activity and outcomes for leadership and relevant stakeholders.
- Perform analysis on refund requests for inpatient clinical accounts.
Nonessential Tasks
- Participate in training sessions to educate clinical and administrative staff on common causes of denials and best practices for preventing them.
- Support the revenue cycle team with special projects related to claim denials, clinical criteria, and reimbursement improvement.
- Assist in the development of process improvements aimed at reducing denial rates.
Required Education and License/Qualifications
- Bachelors degree in Nursing, Healthcare Administration, or a related field required.
- 3+ years of experience in clinical appeals, utilization management, or revenue cycle operations within a healthcare setting.
- Strong knowledge of payer policies, medical necessity criteria, and healthcare reimbursement processes.
- Excellent analytical, organizational, and problem-solving skills.
- Strong written and verbal communication skills, with the ability to craft persuasive appeal letters.
- Proficiency in using appeals management software and electronic health records systems (Epic preferred).
- Ability to work independently, prioritize tasks effectively, and maintain attention to detail in a fast-paced environment.
Certification Requirement
- RN or clinical certification preferred.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Our Commitment To You
Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes:
Compensation
- Base compensation within the positions pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift differential, on-call
- Opportunity for annual increases based on performance
Benefits - .5 To 1.0 FTE
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
Benefits - .001 To .49 FTE
- Paid Leave Hours accrued as you work
Employee Health Requirements
Exposure/Sensory Requirements
Exposure To
- Chemicals: Refer to MSDS manual
- Video Display Terminals: Average
- Blood and Body Fluids: Diagnostic composite of patients, frequent contact with intravenous devices, and high potential for contact with contaminated body fluids (blood, vomitus, stool) and administration of blood does create a high risk. Use of needleless IV system, universal precautions and protective equipment minimize risk.
- TB or Airborne Pathogens: Patient diagnostic presentations do pose high risk. Usage of protective wear and universal precautions minimize risk.
Sensory Requirements (speech, Vision, Smell, Hearing, Touch)
- Speech: Required to communicate with patient/families/staff/doctors, coworkers, ancillary personnel and other department heads. Ability to ask for help.
- Vision: Required to perform necessary assessments of patient status, medication administration, CIS usage, and reading active orders and lab reports.
- Smell: Helpful to note presence of incontinence, vomitus, blood; electrical/fire safety.
- Hearing: Necessary to hear alarms, calls for help and to hear patient verbalizations. Necessary to hear lung, bowel and heart sounds. Needed to hear alarms (i.e., fire, codes via PA system).
- Touch: Necessary to perform percussive assessments and to comfort patients. Also needed to manipulate tools and equipment.
Activity/Lifting Requirements
Percentage of time during the normal workday the employee is required to:
- Sit: 10%
- Twist: 4%
- Stand: 40%
- Crawl: 0%
- Walk: 25%
- Kneel: 1%
- Lift: 10%
- Drive: 0%
- Squat: 1%
- Climb: 1%
- Bend: 30%
- Reach above shoulders: 3%
The weight required to be lifted each normal workday according to the continuum described below:
- Up to 10 lbs: Frequently
- Up to 20 lbs: Frequently
- Up to 35 lbs: Frequently
- Up to 60 lbs: Occasionally
- Up to 75 lbs: Not Required
- Up to 100 lbs: Not Required
- Over 100 lbs: Not Required
Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting patients off their beds that are unable to move independently is done with assistive lifting equipment. Horizontal movement of patients to and from carts/beds who are unable to move independently is done with assistive lifting equipment. Lifting equipment - carry 25'- 150' waist high (IV bags, patient trays, charts). Filled laundry bags are filled half full so as not to weigh over 35#. Carry fire extinguishers up/down 3-4 flights of stairs and several yards in emergency.
Maximum consecutive time (minutes) during the normal workday for each activity:
- Sit: 30
- Twist: 15
- Stand: 60
- Crawl: 0
- Walk: 10
- Kneel: 0
- Lift: 5
- Drive: 0
- Squat: 2
- Climb: 1
- Bend: 15
- Reach above shoulders: 2
Repetitive Use Of Hands (Frequency Indicated)
- Simple grasp up to 10# Normal weight:
- Pushing & pulling - 50-200#: Occasionally
- Fine Manipulation: Typing in computer, omnicell, using pens to chart, drawing up meds in syringe and administration, starting IV's. Leg Strength - up to 50#: Occasionally- (repetitive use of foot or feet in operating machine control: utilized in positioning beds during transport; x-ray, surgery or in an emergency situation from floor to floor, locking beds or cardiac chairs.)
Environmental Factors & Special Hazards
- Environmental Factors (Time Spent):
- Inside hours: 12
- Outside hours: 0
- Temperature: Normal Range
- Lighting: Average
- Noise levels: Average
- Humidity: Normal Range
- Atmosphere: Odors
- Special Hazards: Radiation, Chemical, Explosive - Chemical-drugs; Explosive-oxygen; Radiation cesium implants and radioactive iodine therapy.
- Protective Clothing Required: Gowns, gloves, goggles, masks, HEPA masks for TB.
Pay Range
USD $31.40 - USD $41.21 /Hr
See All 26 Mid Level Clinical Analyst Jobs
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Find JobsMid Level Clinical Analyst Job Market
Who's Hiring
Top Industries Hiring
- Healthcare & Medical Services18
- Education6
- Insurance2
Mid Level Clinical Analyst Jobs: Frequently Asked Questions
How do I get a mid level clinical analyst job?
Position your experience around ownership and impact: highlight projects you led independently, systems you improved, and decisions you made with minimal direction. Tailor your resume to show depth in clinical data workflows, EHR platforms, or quality metrics relevant to each role. Employers at this level want analysts who can move from task-taker to problem-solver, so lead with outcomes, not just responsibilities.
Which companies hire mid level clinical analysts?
Companies hiring mid level clinical analysts right now include Excellus BCBS, Novant Health, and HonorHealth, based on current listings on Migrate Mate as of September 2026. Hiring at this level comes from a mix of large health systems, managed care organizations, and health technology companies that need analysts who can operate with significant autonomy on complex clinical data challenges.
Are there remote mid level clinical analyst jobs?
Yes, remote and hybrid options are widely available at this level. About 44% of mid level clinical analyst openings are remote or hybrid as of September 2026, reflecting how much of this work centers on data systems and reporting tools that don't require on-site presence. On-site roles tend to concentrate in hospital and health system environments where direct collaboration with clinical teams is part of the role.
How do I move up to a mid level clinical analyst role?
Growing from an entry level position into a mid level clinical analyst role typically requires building depth in one or two core areas, such as clinical quality metrics, EHR configuration, or claims data analysis, while taking on progressively larger projects. Demonstrating ownership, delivering measurable results, and getting comfortable presenting findings to stakeholders are the clearest signals that you are ready to operate at mid level.
Which industries hire the most mid level clinical analysts?
Mid Level clinical analyst roles concentrate in Healthcare & Medical Services, Education, and Insurance, based on current listings on Migrate Mate as of September 2026. These sectors drive hiring at this level because they manage large volumes of clinical and operational data that require analysts who can work independently, build reporting frameworks, and translate findings into decisions that affect patient care or cost outcomes.