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Medicare Appeals Reviewer I – Dispute Resolution Reviewer I
Tanaq Government Services, LLCMedicare Appeals Reviewer I supports federal clients by reviewing Medicare enrollment appeal and rebuttal cases. Evaluating documentation and issuing independent determinations based on applicable laws and guidelines.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare appeals, healthcare compliance, and regulatory interpretation, with a strong ability to make impartial decisions based on medical evidence and current regulations. Proficient in conducting thorough research and staying updated on healthcare practices and policies.
Highest-signal resume keywords
Medicare Appeals ExperienceHealthcare Regulatory InterpretationHIPAA Compliance KnowledgeMedical Coding CertificationMicrosoft 365 Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical ReviewClinical InterpretationRegulatory ComplianceDecision WritingResearch Skills
Soft Skills
Impartial Decision-MakingEffective CommunicationProblem-Solving
Tools & Technologies
Microsoft ExcelMicrosoft Word
Certifications & Qualifications
Medical Coding Certification
Industry Keywords
CMS GuidelinesNo Surprises ActHealthcare PracticesFederal RegulationsBilling and Appeals
About the role
Key responsibilities & impact- Reviews medical records/case file, writes a decision that is clear, concise, and impartial 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 issues raised by the beneficiary, representative, supplier, and provider 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, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision
- Stays abreast of changes in regulations, medical and healthcare practices, policies and procedures
- Participates in special projects and performs other duties as assigned
Requirements
What you’ll need- One (1) year of Medicare appeals, medical review, clinical, healthcare regulatory interpretation/application, healthcare compliance or related experience in a healthcare setting
- Knowledge and experience following HIPAA regulations and personally identifiable information (PII)
- Experience using Microsoft 365, including Excel and Word
- Must be able to pass Federal and state criminal background checks, as required by client
- Must be able to pass a drug screen, as required by the client
- Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
- Experience working within the federal public health agency environment (preferred)
- Experience in appeals and billing (preferred)
- Previous CMS guidelines or manual knowledge, particularly with the No Surprises Act (preferred)
- Medical Coding certified (preferred)
Benefits
Comp & perks- Health insurance
- Flexible work arrangements
- Paid time off