Medicare Clinical Appeals Reviewer III

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess intricate Medicare appeals and dispute cases.

• Examine clinical documentation thoroughly.

• Analyze federal regulations effectively.

• Deliver appeal decisions backed by medical evidence and policy guidelines.

• Offer independent second-level determinations and resolve disputes.

• Perform research utilizing online federal regulations, contractual policies, standards of medical practice, and other pertinent resources.

• Engage in case-specific verbal discussions.

• Mentor and/or train staff when necessary.

• Execute quality reviews and audits as required.

⛳️ Requirements

• 2-3 years of experience in medical dispute resolution, Medicare appeals, medical review, clinical review, or a comparable healthcare environment.

• Background in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy.

• Proven experience in writing or making appeal or payment determinations.

• Proficient in Microsoft 365 applications, including Excel and Word.

• Must successfully complete Federal and state criminal background checks as mandated by the client.

• Must successfully undergo education, certification, and license verification, along with other professional background checks as required by the client.

• Must be legally authorized to work in the United States without requiring employer sponsorship, either now or in the future.

🏝️ Benefits

• Equal Employment Opportunity Employer.

• Drug-Free Workplace Act of 1988 compliance.

• Accommodations available for individuals with disabilities.