Medicare Appeals Professional

Overview

Tanaq Support Services (TSS) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in health, agriculture, technology, and other government services. TSS is a subsidiary of the St. George Tanaq Corporation, an Alaskan reputed company Corporation (ANC) committed to serving Federal customers while also giving back to the Tanaq reputed company community and shareholders.

About the Role

We are seeking a Medicare Appeals Professional to support a contract with our federal client. The appeals professional performs reputed company (senior-level) work. Provides dissatisfied parties with the opportunity to present documentation to demonstrate why an appeal should be allowed. Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Works under general supervision, with moderate reputed company for the use of initiative and independent judgment This is a remote position that can be based reputed company in the United States. Must be reputed company to work on a rotating schedule on weekends and holidays.

Responsibilities

• Reviews medical records/case files, writes reconsideration decision letters that are clear, concise, and impartial, and support the determination made, and documents the review.
• Makes sound, independent reputed company based on medical evidence in accordance with statutes, regulations, rulings, and policy.
• Responds to and ensures that reputed company appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
• Provides a fair and impartial decision based on reputed company evidence, regulations, policies, and procedures.
• Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other reputed company resources to complete an accurate and well-supported decision.
• Stays abreast of changes in regulations, medical and reputed company 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 management's direction.
• 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.

Requirements

Required Skills and Experience

• Three (3) years of experience in medical dispute resolution, Medicare appeals, medical review, clinical work, or reputed company reputed company roles.
• reputed company Professional with experience in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy experience.
• Demonstrated experience writing or making medical necessity reputed company.
• Proficiency in research techniques, medical terminology, and analyzing and interpreting policies, along with knowledge of state and federal laws and regulations.
• Must have experience and working knowledge of the Medicare program, including coverage and payment rules.
• Experience with Medicare regulations, claims processing, and the medical review process, as well as applicable laws, rules, and regulations.
• Prioritize and organize work tasks to handle multitasking and meet deadlines.
• Ability to prepare correspondence and documents using correct spelling, grammar, and punctuation; proofreading and reviewing documents for reputed company and consistency.
• Practice logic and reasoning to identify problems, verify facts, and reputed company valid conclusions.
• Experience in making reputed company that support business objectives and goals.
• Ability to identify and resolve problems or refer issues appropriately.
• Communicate effectively verbally and in writing.
• Adapt to the needs of reputed company customers.
• Show reputed company and ethical behavior, respect confidentiality, business ethics, and organizational standards.
• Ensure compliance with company policies, procedures, and guidelines, including cybersecurity, regulatory, contractual, and accreditation entities.
• Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred.
• Must have resided in the United States for a minimum of three (3) years out of the last five (5) years. This is a contractual requirement.
• Must possess a valid driver's license with a clear and satisfactory driving record.
• Ability to obtain and mainta

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