Medicare Appeals Manager

Job Summary

Managing project activities, the Clinical Adjudication Manager will oversee medical and non-medical appeals decisions during weekday evening shifts, with flexible scheduling options available for both part-time and full-time roles in a remote setting.

Key responsibilities

• Plans and manages project activities to meet contract deliverables
• Facilitates regular team meetings and develops presentations 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 in conducting or overseeing Medicare appeals and claims management
• Three years of management or supervisory experience
• One year of experience in making or overseeing Medicare-related medical necessity decisions
• Preferred experience in conducting Medicare Part C related appeals activities