Medicare Appeals Specialist

Job Summary

Providing independent second-level determinations for Medicare appeals, the full-time Appeals Professional will review medical records, make impartial decisions based on regulations, and address issues raised by beneficiaries while working remotely and requiring weekend and holiday availability.

Key responsibilities

• Reviews medical records and writes clear, concise decisions that support determinations
• Makes independent decisions based on medical evidence in accordance with relevant statutes and policies
• Conducts research using federal regulations and medical literature to support accurate decision-making

Required qualifications

• Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline
• One year of experience in Medicare appeals, medical review, or healthcare regulatory interpretation/application
• Experience with Medicare Part C related appeals activities is preferred
• Must have resided in the United States for at least three of the last five years