Medical Appeal Specialist

Job Summary

A company is looking for a Medical Appeal Specialist for a contract position that is 100% remote.

Key Responsibilities:

• Review medical records and case files to evaluate appeals and disputes
• Prepare clear, concise, and well-supported written determinations
• Make independent decisions based on medical evidence, regulations, and policies

Required Qualifications:

• 3+ years of experience in Medicare appeals, medical review, or healthcare dispute resolution
• Associate's degree (or equivalent experience) in healthcare or related field
• Strong experience in writing appeal decisions and case documentation
• Knowledge of healthcare regulations, policies, and compliance standards