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