Appeals Professional

Role Overview:

• Serve as an independent decision-maker evaluating medical records, regulatory guidance, and policy documentation.
• Determine validity of appeals related to enrollment denials, suspensions, or revocations.
• Collaborate indirectly with providers, beneficiaries, and stakeholders while maintaining impartiality.

Requirements:

• Minimum of 3 years of experience in Medicare appeals, medical review, or healthcare dispute resolution.
• Strong knowledge of Medicare regulations, claims administration, and federal healthcare policies.
• Excellent written communication and analytical skills, with ability to manage multiple priorities independently.

Benefits:

• Fully remote work arrangement anywhere within the United States.
• Competitive compensation package based on experience.
• Professional development in healthcare policy and appeals processes, plus standard benefits package.