Clinical Appeals Education and Quality Assurance Coordinator

Managed Resources; United States; Remote; USD 69,000 - 79,000; Full time

Benefits offered by this job

Medical,Dental,Vision

Phone stipend

Internet stipend

401(k) match

Paid time off

Holidays

Job summary

Managed Resources, Inc. is seeking a Clinical Appeals Education and Quality Assurance Coordinator for a fully remote, full-time role in the United States.

You will own and enhance the education and QA program across clinical appeals, coding, and denial management workflows, partnering with leadership to drive standardized training and improve client outcomes. The role requires RN and/or coding certification, with expertise in QA programs, InterQual, CMS guidelines, and payer policies.

Qualifications

• RN or coding certification required.
• Experience leading QA programs and training.
• Knowledge of InterQual, CMS guidelines and payer policies.

Responsibilities

• Own and enhance the Clinical Appeals education and QA program.
• Develop QA methodologies, scoring rubrics, and audits.
• Create centralized knowledge base for training materials.
• Lead onboarding programs for new hires and track effectiveness.
• Translate audit findings into performance improvements.

Skills

QA program ownership

Audit frameworks

Adult learning

Training leadership

Healthcare revenue cycle

Education development

InterQual knowledge

CMS guidelines

Payer policies

Regulatory awareness

Education

RN certification

CCS

CPC

CCDS

CDIP

Tools

InterQual

Milliman

CMS guidelines

Payer policies

Job description

Clinical Appeals Education and Quality Assurance Coordinator

Remote | Full-Time | Salary Range: $50.00 - $57.00 per hour

Work Remotely. Grow Professionally. Feel Valued.

For more than 30 years, Managed Resources, Inc. has partnered with healthcare organizations nationwide to improve performance, strengthen revenue cycle operations, support compliance, and help providers focus on delivering quality patient care.

We’re proud of the work we do, but we’re equally proud of the workplace we’ve built.

At Managed Resources, you’ll find the stability and reputation of an established healthcare consulting firm combined with the accessibility, collaboration, and growth opportunities of a smaller organization. Here, your contributions are visible, your ideas are welcomed, and your work makes a meaningful impact.

Compensation

Salary Range: $50.00 - $57.00 hourly

Actual compensation will be determined based on factors including experience, qualifications, specialized skills, geographic location, and internal equity considerations.

Quick Facts

• Remote
• Full-Time
• Competitive Compensation
• Phone & Internet Stipend
• Medical, Dental, and Vision Benefits (Full-Time Employees)
• 401(k) Retirement Plan with Company Match
• Paid Time Off, Seven Company Holidays, and Two Floating Holidays (Full-Time Employees)
• Professional Development Opportunities
• Employee Recognition Programs

Why Join Managed Resources?

At Managed Resources, employee feedback isn’t collected and forgotten; it helps drive meaningful change.

Employee feedback has contributed to enhancements in employee recognition programs, professional development opportunities, communication initiatives, employee experience improvements, and technology investments. We believe the people closest to the work often have the best ideas.

We believe great work deserves recognition.

Throughout the year, we celebrate employee contributions through appreciation initiatives, recognition programs, milestone celebrations, and professional observances such as Nurses Week and Coding Week. We intentionally create opportunities for employees to feel seen, valued, and appreciated.

A Remote Team That Stays Connected

Remote work shouldn’t mean feeling disconnected.

We foster connection through virtual team events, company celebrations, employee appreciation activities, holiday gatherings, and opportunities for collaboration across teams. Our employees enjoy the flexibility of remote work while remaining part of an engaged and supportive culture.

Opportunities to Learn and Grow

Whether you’re looking to deepen your expertise, expand your skill set, or take the next step in your career, Managed Resources supports continuous learning and professional growth.

Our leaders are accessible, collaborative, and invested in helping employees succeed.

The Best of Both Worlds

As an established organization with more than three decades of success, we offer stability, industry expertise, and long-standing client relationships.

As a smaller organization, employees have the opportunity to build meaningful relationships, gain visibility with leadership, contribute ideas, influence change, and make a measurable impact on the organization.

Your work matters here.

About the Opportunity

The Clinical Appeals Education & Quality Assurance Coordinator serves as the program owner for training, education, and quality assurance across the Clinical Appeals function. This role partners directly with leadership to develop standardized training programs, maintain quality frameworks, identify performance trends, and drive continuous improvement across clinical appeals, coding, CDI, and denial management workflows.

Why This Role Matters

The Clinical Appeals Education & Quality Assurance Coordinator plays a critical role in driving consistency, quality, and continuous improvement across the Clinical Appeals function. By developing standardized training, strengthening quality assurance practices, and transforming performance insights into actionable education, this role helps improve client outcomes, reduce denial risk, and support operational excellence.

What You’ll Gain

• Flexibility of a remote work environment
• Visibility and access to leadership
• Opportunity to contribute ideas and influence change
• Professional development and career growth opportunities
• Meaningful work supporting healthcare organizations nationwide
• A collaborative culture that values employee success, recognition, and work-life balance

What You’ll Do

• Own and continuously enhance the Clinical Appeals education and QA program
• Develop and maintain standardized QA methodologies, scoring rubrics, and audit frameworks
• Establish and manage a centralized knowledge base to ensure consistency and accessibility of training materials
• Identify operational gaps and implement scalable process improvements across training and QA workflows
• Design and lead onboarding programs for new hires, including curriculum development, delivery, and effectiveness tracking
• Develop ongoing education initiatives tied to process changes, regulatory updates, and performance trends
• Facilitate recurring training sessions and targeted skill development workshops
• Evaluate training effectiveness and adjust content based on performance data and audit findings
• Oversee QA audit strategy, including audit scope, frequency, and evaluation criteria
• Ensure QA standards remain aligned with regulatory requirements, payer policies, and internal expectations
• Partner with leadership to identify recurring issues and develop structured remediation plans
• Support client-driven audits and ensure readiness for internal and external review
• Own QA reporting for leadership, including trend analysis, risk identification, and actionable recommendations
• Translate audit findings into measurable performance improvement initiatives

What You’ll Bring

• 6-8+ years of experience in healthcare revenue cycle operations (clinical appeals, coding, auditing)
• RN and/or coding certification required (CCS, CPC, CCDS, CDIP preferred)
• Experience in QA program ownership, education development, or training leadership
• Strong knowledge of InterQual, Milliman, CMS guidelines, and payer policies
• Working knowledge of provider billing guidelines, payer reimbursement policies, and related industry- based standards
• Working knowledge of billing codes, Revenue Codes, CPT’s, NCD/LCDs, etc
• Working knowledge of federal and state specific healthcare laws and regulations
• Experience and knowledge of managed care contracts, account receivables and revenue cycle functions
• Specific knowledge of managed care denials and underpayment decisions
• Ability to instruct educational training to varied groups of adult learners in various settings
• Strong presentation skills with the ability to engage others
• Ability to navigate resistance to change and solve problems effectively
• Excellent oral and written communication skills
• Possess strong organizational skills and attention to detail

Full-Time Employees

• Medical, Dental, and Vision Insurance
• Phone and Internet Stipend
• Company-Paid Life Insurance
• 401(k) Retirement Plan with Company Match
• Paid Time Off
• Seven Company-Observed Holidays
• Two Floating Holidays for Personal Observance
• Professional Development Opportunities
• Employee Recognition Programs

Managed Resources, Inc. is an Equal Opportunity Employer and is committed to creating an inclusive workplace where all employees can thrive.