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.

The Appeals Specialist I is responsible for performing triage, review, analysis, and resolution of facility-submitted appeals, involving non-clinical appeals, and clinical appeals where no new clinical information is received for review. The role focuses on payment, reimbursement, and administrative determinations. Ensuring appeals are processed accurately, thorough, timely and in compliance with client and organization requirements.

Responsibilities

This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of the department and MedReview in general.
- Triage admin appeals to validate appropriateness for review and workflow to follow.



Route appeals appropriately when new information is received that d warrant a clinical review
- Process non-clinical facility appeals including payment disputes, reimbursement amounts, contract interpretation, processing errors. Analyze payment history, contracts, in client(s) applications
- Process clinical appeals when no recent clinical information is submitted
- Determine appeal decisions in accordance with existing policies from client and/or organization
- Provide clear, thorough, and accurate appeal responses
- Coordinate and communicate with Clinical Review teams when new clinical information is received or when escalation is required
- Communicate with various stakeholders to bring forth emergent matters or trends

Qualifications
- Associate degree (healthcare field preferred) or an equivalent combination of education, and relevant work experience
- 1 year experience working in healthcare claims, appeals, billing or revenue cycle
- Experience in han

📌 Appeals Specialist (India)
🏢 Medreview Us
📍 India