Medicare Appeals Specialist

Job Summary

A company is looking for an Appeals Professional III to support Medicare appeal and medical review operations.

Key Responsibilities:

• Review medical records and case files for Medicare appeals
• Make independent medical necessity and reconsideration decisions
• Research Medicare regulations, CMS policies, and clinical guidelines

Required Qualifications:

• 3+ years of experience in Medicare appeals, medical review, or related healthcare experience
• Experience making or supporting medical necessity determinations
• Strong knowledge of Medicare regulations and healthcare compliance
• Clinical background preferred: RN, Physical Therapy, Respiratory Therapy, Occupational Therapy, or related healthcare field
• Must have a Bachelor's or Associate's Degree