Dispute Resolution Reviewer

Job Summary

Providing independent second-level determinations, the full-time remote Dispute Resolution Reviewer will review medical records, write clear and impartial decisions, and ensure all issues raised by beneficiaries and providers are addressed.

Key responsibilities

• Reviews medical records and case files to document and support decision-making
• Makes independent decisions based on medical evidence in accordance with relevant laws and regulations
• Conducts research using federal regulations and medical literature to support accurate decision-making

Required qualifications

• Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or a related discipline
• One year of experience in Medicare appeals, medical review, or healthcare compliance
• Independent Dispute Resolution experience preferred
• Resided in the United States for at least three of the last five years