Appeals Specialist

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MedReview Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💸 Finance

Healthcare • Healthcare Insurance • Finance

MedReview Inc. is a leading provider of advanced payment integrity solutions, specializing in healthcare claims. They work with a wide range of clients, including health plans, government agencies, and payors, to reduce unnecessary waste and save billions of dollars. Their team of highly trained physicians, registered nurses, and certified coders conduct thorough clinical and coding reviews to identify inaccuracies in healthcare claims. MedReview employs proprietary algorithms to analyze complex data and detect suspicious payment trends, offering a unique blend of clinical expertise and advanced technology to maximize efficiencies and improve healthcare cost management.

📋 Description

• Triage administrative appeals to validate appropriateness for review and determine workflow • Route appeals appropriately when new information warrants clinical review • Process non-clinical facility appeals involving payment disputes, reimbursement amounts, contract interpretation, and processing errors • Analyze payment history and contracts in client applications • Process clinical appeals when no new clinical information is submitted • Determine appeal decisions according to client and/or organizational policies • Provide clear, thorough, and accurate appeal responses • Coordinate and communicate with Clinical Review teams when new clinical information is received or escalation is required • Communicate with stakeholders regarding emergent matters or trends

🎯 Requirements

• Associate degree (healthcare field preferred) or an equivalent combination of education and relevant work experience • 1 year of experience working in healthcare claims, appeals, billing, or revenue cycle • Experience handling administrative review of clinical appeals • Strong professional judgment and escalation awareness • Ability to analyze case details and make timely, sound decisions • Ability to quickly learn and navigate new systems and platforms • Basic understanding of claims adjudication processes and terminology • Excellent written and verbal communication skills • Ability to manage tasks and prioritize work effectively • High attention to detail and document accuracy • Proficiency in MS Office applications, including Outlook, Excel, and Word • Ability to multitask, manage a high-volume caseload, and meet strict time-sensitive deadlines • Ability to work independently • Patience and ability to remain calm under pressure amid frequent interruptions • High-speed internet (100 Mbps per person recommended) with secured WIFI • Dedicated workspace with minimal interruptions to protect PHI and HIPAA information • Ability to sit and use a computer keyboard for extended periods

🏖️ Benefits

• Remote work • High-speed internet requirement with secured WIFI • Dedicated workspace with minimal interruptions to protect PHI and HIPAA information