The Appeals Coordinator I assists with administrative work, categorizing appeals, managing documents, and coordinating with other departments to ensure timely resolution of inquiries.
Appeals Coordinator Level I Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Under the direction of the Appeals Department leaders, the Appeals Coordinator level I team member will assist Appeals leadership with daily administrative work within the department. The Appeals Coordinator is responsible for receiving and accurately categorizing and identifying correspondence received from providers, Health Plans, and Clients; entering work items into the various databases; researching case information as needed; electronic file maintenance; and clerical duties as needed.
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
Qualifications
· 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
· Knowledge of organization of medical records and medical claims terminology preferred
· 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.
Remote Work Requirements
Benefits and perks include:
Hourly Range: $22- $24/ hourly.
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. Under the direction of the Appeals Department leaders, the Appeals Coordinator level I team member will assist Appeals leadership with daily administrative work within the department. The Appeals Coordinator is responsible for receiving and accurately categorizing and identifying correspondence received from providers, Health Plans, and Clients; entering work items into the various databases; researching case information as needed; electronic file maintenance; and clerical duties as needed.
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
Qualifications
· 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
· Knowledge of organization of medical records and medical claims terminology preferred
· 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.
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.
Benefits and perks include:
- 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.
Hourly Range: $22- $24/ hourly.
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