Medicare Appeals Specialist

Job Summary

Working remotely on a part-time basis during weekends, the Medicare Appeals Specialist will review medical records, make independent decisions on appeals, and write clear and concise reconsideration letters based on regulations and guidelines.

Key responsibilities

• Reviews medical records and documents decisions in accordance with regulations and policies
• Addresses all appeal issues raised by beneficiaries, representatives, and providers
• Conducts research using federal regulations and medical literature to support decisions

Required qualifications

• Associate's degree or 60 credit hours towards a Bachelor's degree in healthcare or related field
• Three years of experience in medical dispute resolution or Medicare appeals
• Experience in writing medical necessity decisions
• Prior experience with the Part C Qualified Independent Contractor (QIC) effort
• Must have resided in the United States for at least three of the last five years