Appeals Coordinator II

medreview; United States; Remote; USD 59,000 - 65,000; Full time

Benefits offered by this job

100% Remote Position

Quarterly Bonus Opportunity

Collaborative team environment

Professional growth opportunities

Job summary

MedReview is seeking an Appeals Coordinator II for our remote team. You will manage and resolve provider appeals, grievances, and complaints while ensuring compliance with client, state, and regulatory requirements.

The role requires strong analytical skills, collaboration with clinical staff and leadership, and the ability to meet strict deadlines in a fast-paced environment. A 100% remote position with potential quarterly bonuses and opportunities for professional growth are offered.

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.

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 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.

Skills

Analytical thinking

Critical thinking

Time management

Verbal & written communication

Independent work

HIPAA compliance

Education

Associate's Degree

Tools

Excel

WebStrat for DRG pricing

Job description

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.