Medicare Appeals Representative

Job Summary

To support the Medicare appeals process, the part-time hourly Medicare Appeals Representative will respond to first-level appeal requests, review processed claims against Medicare policies, and collaborate with appeal nurses while working remotely in approved states.

Key responsibilities:

• Review and respond to customer requests for Medicare Redetermination Notices (MRN) on a post-claim basis
• Analyze claims for coding accuracy and medical necessity, and refer cases to appeal nurses when needed
• Prepare decision letters and document actions taken on claims to ensure compliance with Medicare guidelines

Required qualifications:

• High School diploma or equivalent
• Must have lived in the United States for at least 3 out of the last 5 years
• 2 or more years of recent Medicare experience in customer service, claims processing, or medical billing preferred
• Experience navigating multiple systems and producing quality work in a fast-paced environment
• Proficient in letter writing with attention to detail and grammar