Medicare Appeals Specialist
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
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
