Medicare Appeals Specialist

Job Summary

A company is looking for an Appeals Professional III to provide independent dispute resolution for medical appeals.

Key Responsibilities

• Review medical records and write clear, impartial reconsideration decisions
• Make independent decisions based on medical evidence and relevant regulations
• Address all appeal issues raised by beneficiaries, patients, and providers

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 as a healthcare professional in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy
• Demonstrated experience in writing or making medical necessity decisions
• Medicare experience preferred