Appeals Coordinator I

Summary

Join MedReview, a leader in payment integrity solutions, as an Appeals Coordinator Level I. You will assist Appeals leadership with daily administrative tasks, accurately categorize correspondence, enter data into databases, research case information, maintain electronic files, and perform clerical duties. The role requires strong analytical skills, the ability to multitask, and excellent communication skills. You will interact with various departments to resolve issues and manage a high volume of documents. Remote work is available with specific requirements for internet speed and workspace setup. MedReview offers excellent benefits, including healthcare, 401k matching, generous PTO, wellness programs, and learning and development opportunities.

Requirements

• High school diploma or equivalent
• 2 years’ experience working in the health care industry. Previous work in Release of Information, Medical record management, or Appeals & Grievances preferred
• Ability to handle high volume case load
• Ability to quickly learn and navigate new systems and platforms
• Demonstrated proficiency using computer applications with one or more years entering data into computer systems
• Proficient in MS Excel
• Strong analytical skills with the ability to make timely and sound decisions to meet department standards
• Must be able to multitask and work in a fast-paced environment to meet strict time sensitive deadlines Appeals and Grievance Coordinator level I Job Description
• Good interpersonal and written/oral communications skills
• Completes complex tasks in effective ways
• Ability to work independently with minimum oversight while understanding the importance of asking questions when uncertain
• Must show patience and the ability to remain calm under pressure in an atmosphere of frequent interruptions Remote Work Requirements
• High speed internet (100 Mbps per person recommended) with secured WIFI
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information
• Must be able to sit and use a computer keyboard for extended periods of time

Responsibilities

• Performs accurate categorization and appropriate triage upon receipt of each appeal or inquiry
• Review appeal requests and determine administrative, claims, or clinical appeal and redirects to other functional areas as appropriate. Investigate cases by reviewing database to determine appropriate level of appeal
• Assures timelines and appropriateness of appeals
• Manage large volume of documents including faxing, downloading, and uploading from different databases or SFTP
• Interacts with other departments including Customer Service, Development, MIS, to resolve obstacles
• Work on other duties or tasks as necessary

Preferred Qualifications

Knowledge of organization of medical records and medical claims terminology preferred

Benefits

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
• 401(k) with Employer Match - Join the team and we will invest in your future
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays
• Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional