Medicare Appeals Specialist

Job Summary

A company is looking for an Appeals Professional II.

Key Responsibilities

• Responsible for significant or complex programs and may assist with quality reviews and audits
• Reviews medical records/case files, writes clear and impartial decisions, and documents the review
• Makes independent decisions based on medical evidence in accordance with laws, regulations, and policies

Required Qualifications

• Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline
• Three (3) years of experience in Medicare appeals, medical review, or related healthcare settings
• Experience in Medicare managed care appeals or utilization management is preferred
• Must have resided in the United States for a minimum of three (3) years out of the last five (5) years