MedReview is hiring a
Appeals Coordinator level II

Summary

The Appeals Coordinator Level II at MedReview assists leadership with daily administrative work within the department, managing and resolving appeals, grievances, and complaints. The role requires an Associates Degree and 3+ years' experience in the health care industry, with preference given to those with experience in inpatient claims, DRG and High-Cost Outlier claims, and DRG Pricing using WebStrat.

Requirements

• Associates Degree. Additional years of related experience may be used in place of education requirements
• 3+ years’ experience working in the health care industry
• Knowledge in claim payment methodology
• Good MS Office skills. Particularly Excel
• Excellent problem solving and analytical skills required
• Ability to manage priorities in a complex environment
• Excellent organization and time management skills required
• Excellent written and verbal communication skills
• Takes initiative to proactively identify and solve problems
• Ability to meet strict, time sensitive deadlines
• Ability to cope well with ambiguity and stressful situations
• Must show patience and the ability to remain calm under pressure in an atmosphere of frequent interruptions

Responsibilities

• Prepare and disseminate case file for External Reviews and/or State Fair Hearing
• Manage and monitor all appeals from Non-Participating providers
• Independently prepare well written, customized responses to all provider inquiries/complaints
• Ensure timely review, research, and resolution of appeals, grievances, and complaints within guidelines
• Consult with managers on problem cases and interface with clinical supervisors, account managers, and other personnel in resolving health plan requests or provider inquiries
• Log and track grievances, appeals, and other types of complaints as needed
• Review and determine outcome of appeal/grievance, either independently or in conjunction with clinical appeal staff
• Consult with subject matter experts and resources available within organization to assist in appeal and complaint resolution
• Make critical decisions regarding research and investigation to appropriately resolve all inquiries
• Serve as a liaison to Appeal Coordinator providing guidance and expertise to ensure timely resolution of cases

Preferred Qualifications

• Experience in inpatient claims, DRG and High-Cost Outlier claims preferred
• Experience in DRG Pricing using WebStrat

Benefits

• Medical, Dental, 401K match
• 3 weeks’ vacation plus 11 holidays and more