Appeals Coordinator I (Healthcare)

TL;DR

Appeals Coordinator I (Healthcare): Managing and triaging payment integrity appeals and inquiries with an accent on accurate categorization and electronic file maintenance. Focus on resolving operational obstacles through cross-departmental coordination and ensuring strict HIPAA compliance.

Location: Remote (Must be based in the USA to comply with PHI and HIPAA requirements)

Salary: $22 - $24 per hour

Company

hirify.global is a leading authority in healthcare payment integrity solutions, specializing in DRG Validation, Cost Outlier, and Readmission reviews.

What you will do

• Perform accurate categorization and triage of appeals and inquiries upon receipt.
• Review appeal requests to determine if they are administrative, claims, or clinical and redirect to the appropriate functional area.
• Manage high volumes of documentation including faxing, downloading, and uploading via databases or SFTP.
• Collaborate with Customer Service, Development, and MIS departments to resolve operational obstacles.
• Ensure the timeliness and appropriateness of all processed appeals.

Requirements

• High school diploma or equivalent.
• 2 years of experience working in the healthcare industry, preferably in Medical Record Management or Appeals & Grievances.
• Proficiency in MS Excel and at least one year of experience with data entry into computer systems.
• Ability to maintain a dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
• Ability to handle a high-volume caseload and meet strict time-sensitive deadlines.
• High-speed internet (100 Mbps recommended) with secured WIFI.

Culture & Benefits

• Comprehensive medical, dental, and vision plan options for employees and dependents.
• 401(k) plan with employer match.
• Generous accrued Paid Time Off starting from day one, plus sick leave and holidays.
• Wellness perks including Commuter Benefits and FSAs.
• Investment in professional growth through mentorship and LinkedIn Learning.