Appeals Coordinator II (Healthcare)

Location: 100% remote

Compensation: $28.20 per hour plus quarterly bonus opportunity.

Company

hirify.global provides healthcare payment integrity solutions, including DRG validation, high-cost outlier reviews, readmission reviews, and healthcare claims auditing.

What you will do

• Prepare and distribute case files for external reviews and State Fair Hearings.
• Manage appeals from non-participating providers and track cases through completion.
• Research, investigate, and resolve provider appeals, grievances, and complaints.
• Draft customized written responses to provider inquiries and complaints.
• Review cases and determine outcomes independently or with clinical review staff.
• Collaborate with leadership, clinical staff, account managers, subject matter experts, and other stakeholders on complex cases.

Requirements

• Associate's degree or an equivalent combination of education and relevant experience.
• At least 3 years of experience in the healthcare industry.
• Strong analytical, critical-thinking, problem-solving, organizational, and time-management skills.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities, meet strict deadlines, and work independently.
• Dedicated workspace and secure internet connection required to support HIPAA and PHI compliance.

Nice to have

• Experience with inpatient claims review, healthcare appeals, grievances, or provider relations.
• Knowledge of DRG and high-cost outlier claims.
• Experience using WebStrat for DRG pricing.
• Understanding of healthcare claim payment methodologies.
• Advanced Microsoft Office proficiency, particularly Excel.

Culture & Benefits

• Fully remote work environment.
• Quarterly bonus opportunity.
• Collaborative and supportive team environment.
• Professional growth and development opportunities.
• Work focused on healthcare quality and payment accuracy.