Appeals Specialist II
$50k - $55kMed Review Inc
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 II team member will assist Appeals leadership with daily administrative work within the department. The Appeals Specialist level II performs research, investigation, and analysis of appeals, grievances, and other types of complaints filed by providers and clients to administer timely resolution. Responsible for all aspects of nonclinical appeals and inquiries. Responsibilities Prepare and disseminate case file for External Reviews and/or State Fair Hearing Manage and monitor all appeals from Non-Participating providers Independently prepare well written, customized responses to all provider inquiries/complaints that appropriately and completely address the complainant’s issues and are structurally accurate. Ensure timely review, research, and resolution of appeals, grievances, and complaints within guidelines. Ensures that all complaints are handled and resolved in compliance with timeliness requirements, and at the highest standards for accuracy Consults with managers on problem cases and interfaces with clinical supervisors, account managers, and other personnel in resolving health plan requests or provider inquiries Log and track grievances, appeals, and other types of complaints as needed. Review and determine outcome of appeal/grievance, either independently or in conjunction with clinical appeal staff. Consults with subject matter experts and resources available within organization to assist in appeal and complaint resolution. Make critical decisions regarding research and investigation to appropriately resolve all inquiries Serve as a liaison to Appeal Coordinator providing guidance and expertise to ensure timely resolution of cases Other duties and responsibilities as assigned Qualifications Associates Degree. Additional years of related experience may be used in place of education requirements 3+ years’ experience working in the health care industry Experience in inpatient claims, DRG and High-Cost Outlier claims preferred Experience in DRG Pricing using WebStrat Knowledge in claim payment methodology Good MS Office skills. Particularly Excel Excellent problem solving and analytical skills required Ability to manage priorities in a complex environment. Excellent organization and time management skills required Excellent written and verbal communication skills Takes initiative to proactively identify and solve problems Ability to meet strict, time sensitive deadlines Ability to cope well with ambiguity and stressful situations 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. 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. Salary Range: $50,000- $55,000/ annually. #J-18808-Ljbffr
- Community Health Systems is seeking an Appeal Specialist II - RN to review, analyze, and resolve insurance denials ensuring compliance and accurate reimbursement. This full-time role involves collaborating with various teams to provide trend reports and feedback to improve...SuggestedFull time
- A healthcare solutions company is seeking an Appeals Coordinator to support the Appeals Department with administrative tasks and manage appeals and complaints. The ideal candidate will have 3+ years of healthcare experience, a strong background in claims processing, and...SuggestedRemote work
$24.76 - $33.17 per hour
...opportunities are posted here as they become available. Authorization Specialist II #Full Time #Remote The 61st Street Service Corporation,... ...regarding authorizations status or denials. Submits appeals in the event of denial of prior authorizations or denial of payment...SuggestedRemote jobHourly payFull timeWork at officeLocal areaImmediate start- THE POSITION: The Program Specialist II will provide dedicated support to patients and doctors for activities related to benefit coverage,... ...issues related to payments, reimbursements, payment denials, and appeals. Make outbound calls to customers for additional information....SuggestedLocal area
- A leading pediatric health system is seeking a Coder II, Inpatient, to assign ICD diagnosis and procedure codes for inpatient medical records. This full-time position requires strong coding skills with a 95% accuracy rate and a commitment to professional development. Applicants...SuggestedRemote jobFull time
- TeamHEALTH is looking for a Denials and Appeals Representative to handle denials and appeals for patient accounts in a cooperative team environment. The ideal candidate has at least two years of experience with insurance denial processes. Responsibilities include processing...Remote job
- ...Hong Kong Study Skills Research Institute is hiring a Remote Coder II to enhance our corporate revenue cycle team. The ideal candidate will have experience in cardiology coding and will review and sequence codes to ensure accurate reimbursement and address coding denials...Remote workWork from homeMonday to Friday
$71.1k
...Specialist II, Retail Brand Marketing, NYC The annual base salary for this position ranges from $71,100.00 in our lowest geographic market to $140,700.00 in our highest geographic market. Actual salary will vary based on a candidate's location, qualifications, skills and...Seasonal workShift work- ...A healthcare company is seeking a skilled Appeals Processor III to work remotely in the United States. This role involves reviewing and processing healthcare appeals related to Medicaid or Medicare coverage decisions. The ideal candidate will have at least 2 years of experience...Remote work
$29.16 per hour
...Salary Starting at $29.16 / hr Overview LPNs wanted wanted for an in home Community Engagement Specialist II, Full-time hours prefered for approximately three months with the opportunity to transition to the Elderwood Network at project completion....Full timeLocal area- ...Level I H23A – $37,280.75 + Full State Employee Benefits Level II H23B – $40,077.79 + Full State Employee Benefits Level III H23C... ...extended, and/or weekend hours. Minimum Qualifications Child Welfare Specialist, Level I Completion of 90 hours from an accredited college or...Permanent employmentLocal areaWeekend work
$45k - $65k
...Records Management Specialist II Employment Type: Full-Time, Mid-Level Department: Office Support CGS is seeking an experienced Records Management Specialist to provide administrative support for a large Federal agency initiative. CGS brings motivated, highly...Full timeWork at officeRemote workFlexible hours$21 - $24 per hour
...Company Description Join Our Passionate Team as a Mental Health Specialist II (MHS II) - Make a Lasting Impact Every Day! At Dungarvin, we are more than a provider of support services - we're a mission-driven team rooted in respect, response and choice. Since 19...Shift workWeekend work- ...Scientist II or III - Metrology Specialist We are looking to fill a position working as a full‑time employee of Parexel FSP on a long‑term assignment onsite at one of our clients located in Rahway, NJ. This position offers full benefits, sick time, 401(k), paid holidays...Full time
- A leading construction firm in the United States is seeking a General Maintenance Technician II responsible for leading daily work orders and performing preventative maintenance tasks. With a high school diploma and 3+ years of relevant experience in maintenance, the candidate...
$28.5 - $43 per hour
## Specialist II, Manufacturing Process Coordinator (Night Shift)Applylocations: USA - OH - West Chestertime type: Full timeposted on: Posted 2 Days Agojob requisition id: R-106882A career at Resilience is more than just a job - it’s an opportunity to change the future....Hourly payLocal areaWork visaShift workNight shift- A prominent financial institution is seeking a Personal Banker II in Oklahoma. This role involves building and retaining customer relationships while driving sales of financial products. Candidates should have a high school diploma and preferably 1-3 years of banking experience...
$23.69 - $32 per hour
A healthcare administrative support organization is seeking an Accounts Receivable Specialist II. This fully remote role involves following up on unpaid accounts, researching claim denials, and communicating with patients and insurance companies. Candidates should have...Remote jobHourly pay$45k - $65k
CGS Federal (Contact Government Services) is seeking a Records Management Specialist II for a full-time position in New York, NY. As a specialist, you will provide administrative support for a large federal agency initiative while managing records and files systematically...Full timeWork at office$34.93k - $38.59k
College Print Shop Specialist (Level I, II, III‑Provisional) General Duties Maintains production standards, quality control, and safety standards. Sets up, operates, and maintains folding, saddle stitching, collating, binding, punching, padding, and cutting equipment...Full timePart time$26.73 - $40.1 per hour
CAI Cox Automotive Corp Svcs., LLC is seeking a Mobile Diesel Tech II to perform preventative maintenance and repairs on diesel vehicles. This role requires hands-on experience with a variety of truck systems and certifications. Offering a pay rate of $26.73 - $40.10/hour...- A mental health services provider in New York is seeking a Behavioral Health Specialist II to join their team. The role involves providing community-based counseling and support for individuals with serious mental illnesses. Responsibilities include case management, crisis...
$73.9k - $111.6k
Job Title Mental Health Specialist II, III or IV Location Pendleton FLSA 1 FTE (Expectation to work 40 hours a week) Exempt or Non‑Exempt depending on education level Supervisor Clinical Supervisor Pay Grade MHS IV - B12 ($73,900 - $111,600 annually) Exempt - Requires...For contractorsWork at officeImmediate startRelocation packageLong distanceFlexible hoursNight shift$18.5 - $20 per hour
A healthcare provider is seeking an Accounts Receivable Specialist II to join their Revenue Cycle Management team. This remote position involves handling complex accounts receivable issues, ensuring timely resolution of insurance claims. Candidates should have at least...Remote job- A leading entertainment venue in New York seeks a Purchasing Specialist II to manage purchasing processes, negotiate contracts, and ensure the timely delivery of quality materials. Responsibilities include monitoring purchase orders, conducting cost analyses, and maintaining...Full timeContract work
- Professional Coding Specialist II Remote work eligible for candidates residing in AR, KS, MO, OK, or TX. Work full‑time remotely or hybrid. The role involves performing complex professional coding across multiple specialties and settings, ensuring accurate documentation...Full timeRemote work
$74k - $82k
A leading pharmaceutical company in the United States is seeking a Manufacturing Maintenance Specialist II to support their manufacturing plant's operations and compliance with Good Manufacturing Practices (cGMP). The ideal candidate will have a high school diploma or equivalent...- ...partners, and external agencies as necessary to promote person‑centered recovery goals. Applicants hired as a Crisis Intervention Specialist II will perform duties as a Credentialed Mental Health Screener. The incumbent is considered essential personnel and must report to...Local areaShift workNight shiftRotating shiftWeekend workAfternoon shift
- Case Western Reserve University is looking for a Facility Safety Specialist II. This role involves managing safety programs, ensuring compliance across renovation sites, and conducting training. Candidates need a Bachelor's degree in safety-related fields and 5 to 10 years...
- ClearStar, Inc. is searching for a Global Operations Specialist II to oversee escalated background screening cases. With 2-4 years in compliance-driven operations and a solid understanding of FCRA requirements, you will enhance processes and ensure high-quality outcomes...Remote work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Appeals Specialist II. Be the first to apply!
- live chat specialist New York, NY
- mental health specialist New York, NY
- cash reconciliation specialist New York, NY
- instructional technology specialist New York, NY
- channel specialist New York, NY
- privacy specialist New York, NY
- assessment specialist New York, NY
- asset protection specialist New York, NY
- sourcing specialist New York, NY
- program specialist New York, NY

