Medicare Appeals Manager

Job Summary

Managing project activities in a remote capacity, the full-time Clinical Adjudication Manager will oversee medical and non-medical appeals decisions while ensuring contract deliverables are met and effective communication is maintained.

Key responsibilities

• Plans and manages project activities to meet contract deliverables
• Facilitates regular team meetings and develops instructional materials related to project responsibilities
• Oversees the administrative processing of appeals and coordinates workflow among internal staff and subcontractors

Required qualifications

• Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline
• Five years of experience conducting or overseeing Medicare appeals or medical review of Medicare claims
• Three years of management or supervisory experience
• One year of experience in writing or overseeing Medicare-related medical necessity decisions
• Experience in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy is preferred