Grievance Appeals Coordinator I

Randstad USA; Fort Lauderdale (FL); Remote; USD 31,000 - 32,000; Full time

Job summary

Randstad USA in Fort Lauderdale is seeking a Medicare Appeals Coordinator to own retrospective authorization appeals and high-priority escalated cases. You will navigate complex claims histories, collaborate with Clinical, Intake/Triage, Claims, and leadership to drive audit-ready, compliant outcomes.

The ideal candidate has 2+ years in Medicare grievance and appeals processing, strong attention to detail, and the ability to manage high-volume inventories while meeting tight deadlines.

Qualifications

• 2+ years in Grievance and Appeals within healthcare or managed care.
• Proven Medicare appeals regulations knowledge and case processing.
• Strong analytical, detail-oriented, and deadline-driven mindset.

Responsibilities

• Investigate and resolve retrospective authorization appeals and escalated Medicare cases per guidelines.
• Research documentation and claims history across internal systems for compliant resolutions.
• Collaborate with Clinical, Intake/Triage, Claims, and leadership to coordinate outcomes.
• Maintain audit-ready records and track daily inventory to avoid aging cases.
• Identify bottlenecks and drive continuous process improvements.

Skills

Medicare Appeals

Analytical Research

Inventory Management

Education

High School

Job description

In this role as a Medicare Appeals Coordinator, you will take ownership of retrospective authorization appeals and high-priority escalated cases. You will dive into complex claims histories, collaborate closely with Clinical, Intake/Triage, and operational partners, and navigate multi-system environments to drive fair, audit-ready, and compliant outcomes. The ideal candidate brings a sharp eye for detail, sound judgment under tight deadlines, and a proven track record in Medicare grievance and appeals processing. If you are an organized self-starter who excels at balancing competing priorities and solving complex operational puzzles, you will fit right in with our high-performing team.

Key Responsibilities

• Investigate, review, and resolve retrospective authorization appeals and escalated Medicare cases in strict accordance with regulatory guidelines.
• Research clinical documentation, authorization files, and claims history across multiple internal systems to determine compliant case resolutions.
• Partner cross-functionally with Clinical, Intake/Triage, Claims, and leadership teams to coordinate case outcomes and mitigate operational risks.
• Maintain audit-ready documentation and track daily inventory to ensure zero aging cases and strict turnaround-time compliance.
• Identify operational bottlenecks, escape processing risks proactively, and champion continuous process improvements.

Qualifications & Critical Skills: 2+ years of Grievance and Appeals experience within healthcare or managed care. Proven expertise in Medicare appeals regulations, case processing, and turnaround times. analytical research, critical thinking, and independent decision-making capabilities. Demonstrated ability to manage high-volume inventories and prioritize competing deadlines. Proficient in navigating complex, multi-screen database systems in a remote setting. Excellent written and verbal communication skills; dedicated home office setup.

salary: $22.46 - $22.47 per hour

shift: First

work hours: 8 AM - 5 PM

education: High School

Responsibilities

• Investigate, review, and resolve retrospective authorization appeals and escalated Medicare cases in strict accordance with regulatory guidelines.
• Research clinical documentation, authorization files, and claims history across multiple internal systems to determine compliant case resolutions.
• Partner cross-functionally with Clinical, Intake/Triage, Claims, and leadership teams to coordinate case outcomes and mitigate operational risks.
• Maintain audit-ready documentation and track daily inventory to ensure zero aging cases and strict turnaround-time compliance.
• Identify operational bottlenecks, escape processing risks proactively, and champion continuous process improvements.

Skills

• Medicare Appeals
• Analytical Research
• Inventory Management

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

Experience

• Experienced
• 2 years

Education

• High School