Medicare Appeals Specialist

Job Summary

A company is looking for a Redetermination (Appeals) Specialist.

Key Responsibilities

• Perform non-medical reviews and process redetermination letters, ensuring accuracy and compliance with established timelines
• Prepare unit reports, analyze and interpret workload data, and address processing issues using various software tools
• Update letters, templates, and departmental documents as needed, and gather documentation for legal inquiries and administrative requests

Required Qualifications

• High School Diploma or equivalent required; Associate's or Bachelor's degree preferred
• Minimum of 2 years of relevant experience in healthcare, insurance, or Medicare/Medicaid services
• Customer service experience preferred
• Medicare-specific experience preferred but not required; comprehensive training provided