Remote Appeals Specialist

Job Summary

Providing independent dispute resolution, the full-time Remote Appeals Specialist will review medical records, make impartial decisions based on regulations and evidence, and address all appeal issues raised by patients and providers.

Key responsibilities

• Reviews medical records and writes clear, concise dispute resolution decisions
• Makes independent decisions based on medical evidence and relevant regulations
• Conducts research on federal regulations and healthcare practices to support decisions

Required qualifications

• Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline
• Three years of experience in medical dispute resolution or Medicare appeals
• Experience in healthcare professions such as Nursing, Physical Therapy, or Occupational Therapy
• Demonstrated experience in writing or making medical necessity decisions
• Preferred experience with Medicare Part D