Appeals Coordinator II

Job Summary

A company is looking for an Appeals Coordinator II to assist with administrative tasks and manage appeals within the department.

Key Responsibilities

• Prepare case files for External Reviews and manage appeals from Non-Participating providers
• Ensure timely review and resolution of appeals, grievances, and complaints while maintaining compliance with guidelines
• Consult with managers and clinical supervisors to resolve complex cases and provide guidance to Appeal Coordinators

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 experience
• Familiarity with DRG Pricing using WebStrat and claim payment methodology
• Proficient in MS Office, especially Excel
• Ability to manage priorities and meet strict deadlines in a complex environment