Remote Healthcare Appeals Coordinator II — Payment Integrity

MedReview; New York (NY); Remote; USD 58,000 - 64,000; Full time

Benefits offered by this job

100% remote position

Quarterly bonus opportunity

Collaborative team environment

Meaningful work impacting healthcare

Growth and development opportunities

Job summary

MedReview is seeking an Appeals Coordinator II to join our fully remote team. You will manage and resolve appeals, grievances, and provider inquiries, ensuring compliance with client, state, and regulatory requirements.

The role emphasizes investigative work, attention to detail, and the ability to work independently in a fast-paced environment. A healthcare background and strong communication skills are essential.

Qualifications

• Analytical thinking, problem-solving, and strong organizational skills.
• Excellent written and verbal communication abilities.
• Ability to manage multiple priorities and meet deadlines.
• Self-starter who works independently and remains 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 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 with 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

Communication skills

Time management

Independent work

Deadline-driven

Education

Associate's Degree or equivalent

Tools

Microsoft Excel

WebStrat

Job description

MedReview is seeking an Appeals Coordinator II to join our fully remote team. You will manage and resolve appeals, grievances, and provider inquiries, ensuring compliance with client, state, and regulatory requirements.

The role emphasizes investigative work, attention to detail, and the ability to work independently in a fast-paced environment. A healthcare background and strong communication skills are essential.