Medical Appeals Specialist

Job Summary

A company is looking for an Appeals Professional IV (Weekend Work).

Key Responsibilities

• Facilitates discussions with appellants/requestors/providers to gather additional documentation and understanding of appeal/dispute issues
• Reviews medical records/case files and writes clear, concise, and impartial reconsideration/dispute resolution decisions
• Makes independent decisions based on medical evidence in accordance with relevant statutes, regulations, and policies

Required Qualifications

• Associate's degree or 60 credit hours towards a Bachelor's degree in healthcare or a related discipline, or equivalent experience
• Five years of experience in medical dispute resolution, Medicare appeals, or related healthcare settings
• Experience in writing or making medical necessity decisions
• Background in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy
• Experience with Medicare Fee for Service or Managed Care