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 evidence, and respond to inquiries from beneficiaries and providers, all while working remotely and on weekends as needed.

Key responsibilities

• Reviews medical records and case files to write clear and impartial decisions supporting the determinations made
• Makes independent decisions based on medical evidence in accordance with relevant statutes and policies
• Conducts research using federal regulations and medical literature to ensure accurate and well-supported decisions

Required qualifications

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