Healthcare Appeals Specialist
Location: Remote
Compensation: Salary
Staff Reviewed: Mon, Jan 06, 2025
This job expires in: 23 days
Job Summary
A company is looking for an Appeals Professional III (Healthcare Professional).
Key Responsibilities:
- Reviews medical records and writes clear, concise, and impartial reconsideration/dispute resolution decisions
- Makes independent decisions based on medical evidence in accordance with relevant statutes and policies
- Addresses all appeal/dispute issues raised by beneficiaries, patients, representatives, and providers
Required Qualifications:
- Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or a related discipline
- Three years of experience in medical dispute resolution or Medicare appeals in a healthcare setting
- Experience in writing or making medical necessity decisions
- Background in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy
- Experience with Medicare
COMPLETE JOB DESCRIPTION
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