Medicare Appeals Specialist

Job Summary

A company is looking for an Appeals Professional III to perform complex work related to Medicare appeals.

Key Responsibilities

• Reviews medical records and writes clear, concise reconsideration decision letters
• Makes independent decisions based on medical evidence and relevant regulations
• Conducts research and stays updated on changes in healthcare regulations and practices

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 or Medicare appeals
• Experience in nursing, physical therapy, respiratory therapy, or occupational therapy is preferred
• Demonstrated experience writing or making medical necessity decisions
• Residency in the United States for at least three of the last five years