Licensed Appeals Professional
Job Summary
Providing independent second-level determinations, the full-time Licensed Appeals Professional will review medical records and write clear, impartial decisions on appeals and disputes while working remotely.
Key responsibilities
- Reviews medical records and writes clear reconsideration/dispute resolution decisions
- Makes independent decisions based on medical evidence in accordance with relevant regulations and policies
- Conducts research on federal regulations and medical practices to support accurate decision-making
Required qualifications
- Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline
- Three years of experience in medical dispute resolution or Medicare appeals in a healthcare setting
- Experience in writing medical necessity decisions
- Preferred experience in Medicare Part A Appeals or related healthcare coding
- Resided in the U.S. for at least three of the last five years
Complete Job Description
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