Appeals Coordinator

Integrated Pain Management Medical Group, Inc.•Walnut Creek, CA

6h•$29 - $33•Remote

About The Position

The Appeals Coordinator is responsible for managing Medicare appeals across all applicable levels in accordance with CMS regulations. This role serves as the subject matter expert for Medicare denial resolution, ensuring timely, compliant, and well-supported appeal submissions. The Appeals Coordinator partners closely with AR, coding, clinical, and compliance teams to maximize reimbursement and reduce Medicare audit risk. This is a remote role.

Requirements

3–5+ years of Commercial denial management experience
Strong understanding of payer contracts and reimbursement methodologies
Experience with denial trend reporting and prevention
Experience supporting ALJ-level Medicare appeals
Excellent written communication and analytical skills
Excel proficiency preferred (reporting, tracking)

Responsibilities

Prepare, review, and submit Medicare appeals at all applicable levels, including as appropriate:
Redeterminations,
Reconsiderations, and
Administrative Law Judge (ALJ) appeals
Review and respond to Medicare denial types including:
Medical necessity denials,
LCD/NCD-related denials,
Frequency and utilization edits, and
Documentation or modifier-related issues.
Draft clear, persuasive, payer-specific appeal letters supported by appropriate and comprehensive clinical documentation.
Ensure all appeal submissions comply with CMS regulations and Medicare Administrative Contractor (MAC) requirements.
Track appeal deadlines, filing timelines, submission status, decisions, and financial outcomes to ensure timely follow-up and regulatory compliance.
Maintain organized, accurate, and audit-ready documentation for all appeal activity.
Analyze appeal outcomes to identify recurring Medicare denial trends and root causes.
Collaborate with Accounts Receivable, Coding, Billing, and Clinical teams to provide feedback and support denial prevention efforts.
Contribute to process improvement initiatives designed to enhance compliance, strengthen documentation practices, and improve overall revenue cycle performance.
Assumes other responsibilities as appropriate to the position and organizational needs