Appeals Coordinator II

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.

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.

• 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.

• 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.

• 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.

• 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

• 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.