Appeals Coordinator II

A company is looking for an Appeals Coordinator II to assist with administrative work in the Appeals Department. Key Responsibilities Perform research, investigation, and analysis of appeals, grievances, and complaints to ensure timely resolution Prepare and disseminate case files for external reviews and manage all appeals from non-participating providers Log and track grievances and consult with managers on problem cases to facilitate resolution Required Qualifications Associates Degree or equivalent experience in the healthcare industry 3+ years of experience in healthcare, with a preference for inpatient claims and DRG knowledge Familiarity with claim payment methodology and DRG pricing using WebStrat Proficient in MS Office, particularly Excel Ability to manage priorities in a complex environment and meet strict deadlines

Apr 15, 2025 - 04:30

A company is looking for an Appeals Coordinator II to assist with administrative work in the Appeals Department. Key Responsibilities Perform research, investigation, and analysis of appeals, grievances, and complaints to ensure timely resolution Prepare and disseminate case files for external reviews and manage all appeals from non-participating providers Log and track grievances and consult with managers on problem cases to facilitate resolution Required Qualifications Associates Degree or equivalent experience in the healthcare industry 3+ years of experience in healthcare, with a preference for inpatient claims and DRG knowledge Familiarity with claim payment methodology and DRG pricing using WebStrat Proficient in MS Office, particularly Excel Ability to manage priorities in a complex environment and meet strict deadlines