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 State Fair Hearings
• Manage and monitor all appeals from Non-Participating providers
• Ensure timely review, research, and resolution of appeals, grievances, and complaints

Required Qualifications

• Associates Degree or equivalent related experience
• 3+ years' experience in the healthcare industry
• Experience in inpatient claims, DRG, and High-Cost Outlier claims preferred
• Knowledge in claim payment methodology
• Good MS Office skills, particularly in Excel