At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As a recognized leader in payment integrity solutions, we specialize in DRG Validation, High-Cost Outlier Reviews, Readmission Reviews, and healthcare claims auditing that help ensure quality and financial accuracy across the healthcare system.
We are seeking a detail-oriented and experienced Appeals Coordinator II to join our remote team. This role is ideal for a healthcare professional who thrives in a fast-paced environment, enjoys investigative work, and has a passion for resolving complex provider appeals and inquiries.
What You'll DoAs an Appeals Coordinator II, you will play a critical role in managing and resolving appeals, grievances, and provider complaints while ensuring compliance with client, state, and regulatory requirements.
Key Responsibilities- Prepare and distribute case files for External Reviews and State Fair Hearings.
- Manage and monitor appeals from non-participating providers.
- Research, investigate, and resolve provider appeals, grievances, and complaints.
- Draft professional, customized written responses to provider inquiries and complaints.
- Ensure all appeals and grievances are processed accurately and within required timelines.
- Collaborate with leadership, clinical staff, account managers, and other internal stakeholders to resolve complex cases.
- Track and maintain appeal and grievance records through completion.
- Review appeal cases and determine outcomes independently or alongside clinical review staff.
- Utilize subject matter experts and organizational resources to support effective resolutions.
- Make sound decisions regarding research, investigation, and case outcomes.
- Provide guidance and support to Appeals Coordinators as needed.
- Perform other duties as assigned.
- Associate's Degree or equivalent combination of education and relevant experience.
- Minimum of 3 years of experience in the healthcare industry.
- Strong analytical, critical thinking, and problem-solving abilities.
- Excellent organization, prioritization, and time management skills.
- Outstanding written and verbal communication skills.
- Ability to manage multiple priorities and meet strict deadlines.
- Self-starter who takes initiative and works independently.
- Ability to remain professional and composed in a deadline-driven environment.
- Experience with inpatient claims review.
- Knowledge of DRG and High-Cost Outlier claims.
- Experience using WebStrat for DRG pricing.
- Understanding of healthcare claim payment methodologies.
- Advanced proficiency with Microsoft Office, particularly Excel.
- Previous experience handling healthcare appeals, grievances, or provider relations.
- 100% Remote Position
- Quarterly Bonus Opportunity
- Collaborative and supportive team environment
- Meaningful work that impacts healthcare quality and payment accuracy
- Opportunities for professional growth and development
- Work with industry experts in payment integrity and healthcare auditing
- High-speed internet connection (100 Mbps recommended).
- Secure Wi-Fi connection.
- Dedicated workspace with minimal interruptions to ensure HIPAA and PHI compliance.
- Ability to sit and work on a computer for extended periods.
Compensation: $28.20 per hour + quarterly bonus opportunity.
Equal Opportunity Employer: MedReview is committed to creating an inclusive workplace and welcomes applicants from diverse backgrounds and experiences.
Skills Required
- Associates degree, or additional related experience in lieu of education
- At least 3 years of experience working in the healthcare industry
- Experience with inpatient claims, DRG, and high-cost outlier claims
- Experience in DRG pricing using WebStrat
- Knowledge of claim payment methodology
- Good Microsoft Office skills, particularly Excel
- Excellent problem-solving and analytical skills
- Ability to manage priorities in a complex environment
- Excellent organization and time management skills
- Excellent written and verbal communication skills
- Ability to proactively identify and solve problems
- Ability to meet strict, time-sensitive deadlines
- Ability to cope with ambiguity and stressful situations
- Patience and ability to remain calm under pressure with frequent interruptions
- High-speed internet and secured Wi-Fi for remote work
- Dedicated workspace with minimal interruptions to protect PHI and HIPAA information
- Ability to sit and use a computer keyboard for extended periods
What We Do
MedReview is a physician-led healthcare services company and a leading authority in payment integrity solutions, offering auditing, utilization management, and clinical reviews to ensure accurate claims processing.
