Appeals Coordinator II

MedReview Inc.; New York (NY); Remote; USD 50,000 - 55,000; Full time

Job summary

A leading healthcare company is seeking an Appeals Coordinator II to assist with administrative tasks in the Appeals Department. This role involves managing appeals, grievances, and complaints, ensuring timely resolutions while collaborating with clinical staff. The ideal candidate will have a strong background in healthcare, excellent communication skills, and proficiency in MS Office. The position offers various benefits, including healthcare options and a 401(k) plan.

Benefits

Healthcare options

401(k) with employer match

Paid time off and holidays

Wellness benefits

Learning and development opportunities

Qualifications

• 3+ years in healthcare experience.
• Experience with inpatient claims and DRG preferred.

Responsibilities

• Manage appeals and prepare case files for reviews.
• Ensure timely resolution of appeals and grievances.
• Consult with managers and clinical staff for resolutions.

Skills

Problem-Solving

Analytical Skills

Communication

Education

Associates Degree

Tools

MS Office

Excel

Job description

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Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. We are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier, and Readmission reviews.

Under the direction of the Appeals Department leaders, the Appeals Coordinator II will assist with daily administrative work within the department.

The role involves research, investigation, and analysis of appeals, grievances, and complaints filed by providers and clients, to facilitate timely resolution. Responsible for all aspects of nonclinical appeals and inquiries.

Responsibilities
This list is not exhaustive. The candidate must be willing and able to assume other roles as needed.

• Prepare and disseminate case files for External Reviews and/or State Fair Hearings
• Manage appeals from Non-Participating providers
• Prepare customized responses to provider inquiries/complaints
• Ensure timely review and resolution of appeals, grievances, and complaints
• Consult with managers and interface with clinical staff to resolve requests
• Log and track grievances and appeals
• Review and determine outcomes of appeals/grievances
• Consult with subject matter experts for resolution assistance
• Make critical decisions regarding research and investigation
• Serve as a liaison to provide guidance and ensure timely case resolution
• Other duties as assigned

Qualifications
- Associates Degree or equivalent experience
- 3+ years in healthcare
- Experience with inpatient claims, DRG, and High-Cost Outlier claims preferred
- Knowledge of claim payment methodology
- Proficiency in MS Office, especially Excel
- Strong problem-solving and analytical skills
- Ability to manage priorities and meet deadlines
- Excellent communication skills
- Ability to work under pressure and handle ambiguity

Remote Work Requirements
- High-speed internet and secure WIFI
- Dedicated workspace
- Ability to sit and use a computer for extended periods

Benefits and Perks
- Healthcare options
- 401(k) with employer match
- Paid time off and holidays
- Wellness benefits
- Learning and development opportunities

Salary Range: $50,000 - $55,000 annually.

Additional Details
- Seniority level: Mid-Senior
- Employment type: Full-time
- Job function: Healthcare Provider
- Industry: Hospitals and Healthcare