Medicare Appeals Reviewer

Job Summary

Reviewing Medicare enrollment appeal cases, the full-time Medicare Appeals Reviewer I will evaluate supporting documentation and issue independent determinations while working remotely from anywhere in the United States.

Key responsibilities

• Reviews medical records and case files to write clear, concise, and impartial decisions
• Makes independent decisions based on medical evidence in accordance with relevant laws and policies
• Conducts research on federal regulations and healthcare practices to support accurate decision-making

Required qualifications

• One year of experience in Medicare appeals, medical review, or related healthcare regulatory roles
• Knowledge of HIPAA regulations and handling of personally identifiable information (PII)
• Experience with Microsoft 365, including Excel and Word
• Associate's degree or 60 credit hours towards a Bachelor's degree in healthcare or a related field, or equivalent experience
• Must pass Federal and state criminal background checks and a drug screen