Appeals Coordinator II

Job Summary

A company is looking for an Appeals Coordinator II to assist with administrative work in the Appeals Department.

Key Responsibilities

• Prepare and disseminate case files for external reviews and manage appeals from non-participating providers
• Ensure timely review, research, and resolution of appeals, grievances, and complaints while maintaining compliance with guidelines
• Consult with managers and subject matter experts to resolve health plan requests or provider inquiries effectively

Required Qualifications

• Associates Degree or equivalent experience in the healthcare industry
• 3+ years of experience in the healthcare sector
• Experience in inpatient claims, DRG, and high-cost outlier claims preferred
• Proficiency in MS Office, particularly Excel
• Knowledge of claim payment methodology