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Medicare Appeals Professional with Licensed nurse

Chags Health Information Technology LLC (C-HIT)

Remote • 10d ago

Easy Apply

Full-time

Depends on Experience

Analyst, FP&A - Medicare/Medicaid COGS & Network Performance

CVS Health

Hartford, Connecticut • Today

Full-time

USD 43,888.00 - 93,574.00 per year

Sr. Healthcare Data Scientist (Medicare/Medicaid)

General Dynamics

Remote • Today

Full-time

USD 97,968.00 - 132,250.00 per year

VP AI ML Engineering, Medicare & Retirement

UnitedHealth Group

Minnetonka, Minnesota • Today

Full-time

USD 200,400.00 - 343,500.00 per year

Medical Review Nurse

Avenue Code, LLC

Remote • 17d ago

Easy Apply

Full-time

80,000 - 90000

Appeals Creation Specialist

The Intersect Group

Remote • 3d ago

Easy Apply

Contract

Depends on Experience

.Net Developer Medicare Billing & Care Management Platforms (CCM/RPM/RTM)

Mind Ware Inc

Hybrid in Atlanta, Georgia • 2d ago

Easy Apply

Full-time, Third Party

160,000 - 165000

PMO Project Manager with Medicare / Medicaid system experience and RAID expertise

ec3 Federal Services

Remote • 2d ago

Easy Apply

Contract

Depends on Experience

Project Manager - PBM - PMP - Claims / Medicare - Medicaid

KE Staffing

Remote • 18d ago

Easy Apply

Contract

$60+

Data Scientist IV - Risk Adjustment: Medicare, Medicaid, ACA

Kaiser Permanente

Oakland, California • Today

Full-time

USD 166,100.00 - 214,940.00 per year

Data Scientist V - Risk Adjustment: Medicare, Medicaid, ACA

Kaiser Permanente

Oakland, California • Today

Full-time

USD 174,400.00 - 225,610.00 per year

RN with Medicaid SME experience Columbia, SC

Software People, Inc.

Columbia, South Carolina • 2d ago

Easy Apply

Third Party, Contract

Medicare / Medicaid Organizational Change Management Lead

Infinite Solutions Inc.

Remote • 5d ago

Easy Apply

Contract

Depends on Experience

RN with Medicaid SME experience

Software People, Inc.

Columbia, South Carolina • 2d ago

Easy Apply

Contract

$$90/hr

Job Details

Skills

Medicare appeals
medical review
Healthcare Professional with Nursing

Summary

Responsibilities:

Reviews medical records/case file, writes a reconsideration decision letter that is clear, concise, andimpartial and supports the determination made, and documents review.
Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation,rulings, and policy.
Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, andprovider/supplier have been addressed.
Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
Conducts research using online federal regulations, contract policy, standards of medical practice, contractmanuals, coverage issues manuals, medical literature, and other related resources to complete an accurateand well-supported decision.
Stays abreast of changes in regulations, medical and healthcare practices, policies and procedures.
Participates in case specific verbal discussions.
Conducts reviews of appeals/disputes with multiple beneficiaries/services in one case.
Plans responses to statistical analysis challenges with assistance from statisticians.
Attends meetings and participates in workgroups at the direction of management.
Conducts quality reviews, as needed.
Serves as a subject matter expert.
Mentors and/or trains staff.
May conduct quality reviews and audits.
Participates in special projects and performs other duties as assigned.

Experience Must:

Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or relatedexperience in a healthcare setting
Licensed nurse with 3 or more years of experience conducting appeals
Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
Demonstrated experience writing or making medical necessity decisions
Experience directly relevant to Medicare managed care appeals or utilization management activities,preferred

Minimum Education Qualifications:

Associate''s degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college oruniversity in healthcare or related disciplineAdditional experience in Medicare appeals, medical review, clinical, or other related experience in ahealthcare setting may be substituted for Associate’s degree on a year per year basis.

C-HIT is an EOE, including disability and veterans.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 90793297
Position Id: 9080134
Posted 10 days ago

Fitment

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Job Details

Skills

Medicare appeals
medical review
Healthcare Professional with Nursing

Summary

Responsibilities:

Reviews medical records/case file, writes a reconsideration decision letter that is clear, concise, andimpartial and supports the determination made, and documents review.
Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation,rulings, and policy.
Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, andprovider/supplier have been addressed.
Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
Conducts research using online federal regulations, contract policy, standards of medical practice, contractmanuals, coverage issues manuals, medical literature, and other related resources to complete an accurateand well-supported decision.
Stays abreast of changes in regulations, medical and healthcare practices, policies and procedures.
Participates in case specific verbal discussions.
Conducts reviews of appeals/disputes with multiple beneficiaries/services in one case.
Plans responses to statistical analysis challenges with assistance from statisticians.
Attends meetings and participates in workgroups at the direction of management.
Conducts quality reviews, as needed.
Serves as a subject matter expert.
Mentors and/or trains staff.
May conduct quality reviews and audits.
Participates in special projects and performs other duties as assigned.

Experience Must:

Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or relatedexperience in a healthcare setting
Licensed nurse with 3 or more years of experience conducting appeals
Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
Demonstrated experience writing or making medical necessity decisions
Experience directly relevant to Medicare managed care appeals or utilization management activities,preferred

Minimum Education Qualifications:

C-HIT is an EOE, including disability and veterans.

Dice Id: 90793297
Position Id: 9080134
Posted 10 days ago

Fitment

Dice Job Match Score™

To see how well you match this job, please log in or create an account.

Once logged in, be sure to complete your profile to get the most accurate match score.

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