Medicare Appeals Specialist

Job Summary

A company is looking for an Appeals Professional III.

Key Responsibilities

• Reviews medical records and writes clear, concise, and impartial reconsideration decision letters
• Makes independent decisions based on medical evidence in accordance with relevant laws and policies
• Addresses all appeal issues raised by beneficiaries, representatives, and providers/suppliers

Required Qualifications

• Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline
• Three years of experience in medical dispute resolution, Medicare appeals, or related healthcare settings
• Experience as a healthcare professional in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy
• Demonstrated experience in writing or making medical necessity decisions
• Must have resided in the United States for at least three years out of the last five years