Telecommute Medical Appeals Professional II

Job is Expired
Location: Nationwide
Compensation: To Be Discussed
Staff Reviewed: Tue, Jun 28, 2022
Job Summary

A healthcare solutions company needs applicants for an opening for a Telecommute Medical Appeals Professional II.

Core Responsibilities of this position include:

  • Reviewing medical records/case file
  • Writing a draft reconsideration decision for clinical cases for physician adjudication
  • Planning formularies and contract provisions

Required Skills:

  • Associate's degree or 60 or more credit hours towards a Bachelor's degree
  • Additional experience in Medicare appeals, medical review, clinical, or other related experience
  • Three (3) years of Medicare appeals, clinical on the record review
  • Healthcare Professional with demonstrated experience researching and applying Medicare rules/policies
  • Medicare Experience
  • Nursing or Pharmacy experience
COMPLETE JOB DESCRIPTION

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