Medicare Appeals Specialist

Job Summary

A company is looking for an Appeals Professional II to support federal clients by managing complex appeals and providing independent determinations.

Key Responsibilities

• Review medical records and case files to write clear and impartial decisions
• Make independent decisions based on medical evidence and relevant regulations
• Conduct research on federal regulations and medical practices to support decisions

Required Qualifications, Training, and Education

• Three years of experience in medical dispute resolution or Medicare appeals
• Proficiency in research techniques and medical terminology
• Experience with Medicare regulations and claims administration
• Associate's degree or 60 credit hours towards a Bachelor's degree in healthcare or related discipline
• Ability to obtain and maintain Public Trust or equivalent security clearance