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Job type
Contract
Work mode
Remote
Level
Not listed
Department
Healthcare
Experience
Not listed
Posted
Aug 21, 2026
About the role
Key Duties/Responsibilities/Accountabilities:
Conducts redetermination reviews per Medicare rules and regulations.
Responds to incoming appeals from Medicare appellants in a professional, timely, and accurate manner. Including letter writing, proofreading with attention to detail following current guidelines.
Researches and identifies claims processing deficiencies and initiates corrective response.
Evaluates all documentation and history needed to determine if it meets outlined policy criteria to ensure accurate and compliant processing in accordance with CMS guidelines.
Submits educational referrals as necessary to decrease redeterminations and allow claims to pay at the lowest level of appeal.
Assists in writing and updating processing guidelines.
Identifies internal/external education and/or training needs, communicates findings, and assists in training if necessary.
Communicates information to appropriate internal and external parties in a timely manner.
Problem solves and researches effectively.
Processes overpayment appeals as needed.
Maintain up-to-date knowledge of working systems, processing instructions, and other relevant resources to ensure efficient and accurate appeal processing.
Maintains knowledge of CMS and Joint Operating Agreement (JOA) requirements
Minimum Qualifications:
High School Diploma or GED
6 months’ work-related experience
Proficiencies:
General PC knowledge
Strong prioritization, analytical and communication skills
