Medicare Appeals Specialist

Job Summary

A company is looking for an Appeals Professional who will handle Medicare appeals and provide independent determinations.

Key Responsibilities

• Review medical records and case files, writing clear and impartial decisions that support determinations
• Make independent decisions based on medical evidence in accordance with relevant statutes and regulations
• Conduct research to ensure accurate and well-supported decisions, addressing all issues raised by involved parties

Required Qualifications

• Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline
• One year of experience in Medicare appeals, medical review, or related healthcare regulatory roles
• Preferred experience in Medicare managed care appeals or utilization management activities
• Must have resided in the United States for at least three of the last five years