About the role
Join a Leader in Healthcare Payment Integrity
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 Do
As 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.
What We're Looking For
Required Qualifications
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.
Preferred Qualifications
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.
Why Join MedReview?
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
Remote Work Requirements
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.
Originally posted on Himalayas