Appeals Specialist

MedReview Inc.

MedReview Appeals Specialist resolving facility payment, reimbursement, and administrative appeals. Reviewing cases, determining policy-based decisions, and coordinating clinical escalations for healthcare payment integrity.

Posted 8/8/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $50,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in processing healthcare claims and appeals, with a strong focus on administrative review, decision-making, and communication with stakeholders. Proficient in analyzing payment history and contracts while ensuring compliance with organizational policies and HIPAA regulations.

Highest-signal resume keywords

Healthcare Claims ProcessingAdministrative Review of Clinical AppealsDecision-Making and Professional JudgmentMS Office ProficiencyAttention to Detail

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims Adjudication ProcessesPayment Disputes AnalysisContract InterpretationWorkflow ManagementData Analysis

Soft Skills

Excellent Written CommunicationExcellent Verbal CommunicationTask ManagementPatience Under PressureMultitasking Ability

Tools & Technologies

MS Office ApplicationsOutlookExcelWord

Industry Keywords

Healthcare AppealsRevenue CyclePHI ProtectionHIPAA ComplianceClinical Review

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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