APPEALS COORDINATOR II

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.