Licensed Medicare Appeals Reviewer

Job Summary

Evaluating complex Medicare appeals and dispute cases, the full-time Licensed Medicare Appeals Reviewer will independently review clinical documentation, interpret federal regulations, and issue determinations while working remotely from the United States.

Key responsibilities

• Review medical records and write clear, impartial reconsideration decisions that support determinations
• Make independent decisions based on current medical evidence, regulations, and policies
• Conduct research and stay updated on changes in regulations and healthcare practices

Required qualifications

• Active license as an RN, PT, RT, OT, or other qualifying licensed healthcare professional
• 2-3 years of experience in medical dispute resolution, Medicare appeals, or a related healthcare setting
• Demonstrated experience in writing or making appeal or payment determinations
• Experience using Microsoft 365, including Excel and Word
• Legally authorized to work in the United States without the need for employer sponsorship