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Medicare Clinical Appeals Reviewer III
Tanaq Government Services, LLCMedicare Clinical Appeals Reviewer III evaluating complex Medicare appeals and dispute cases for Tanaq Support Services. Supporting federal clients with independent determinations and review of clinical documentation.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare appeals and medical dispute resolution, with a strong ability to interpret federal regulations and conduct quality reviews. Proficient in clinical documentation review and capable of mentoring staff while ensuring compliance with legal and professional standards.
Highest-signal resume keywords
Medicare AppealsMedical Dispute ResolutionClinical Documentation ReviewMicrosoft 365Nursing Experience
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 ReviewAppeal DeterminationsPayment DeterminationsQuality ReviewsAuditsResearchFederal Regulations InterpretationStandards of Medical Practice
Soft Skills
MentoringTrainingVerbal Communication
Tools & Technologies
Microsoft ExcelMicrosoft Word
Industry Keywords
Healthcare SettingPhysical TherapyRespiratory TherapyOccupational Therapy
About the role
Key responsibilities & impact- Evaluate complex Medicare appeals and dispute cases
- Review clinical documentation
- Interpret federal regulations
- Issue appeal determinations supported by medical evidence and policy
- Provide independent second-level determinations and dispute resolutions
- Conduct research using online federal regulations, contract policy, standards of medical practice and other related resources
- Participate in case-specific verbal discussions
- Mentor and/or train staff if needed
- Conduct quality reviews and audits as needed
Requirements
What you’ll need- 2-3 years of experience in medical dispute resolution, Medicare appeals, medical review, clinical review, or a related healthcare setting
- Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
- Demonstrated experience writing or making appeal or payment determinations
- 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 education, certification and license verification, as well as other professional background checks, as required by 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
Benefits
Comp & perks- Equal Employment Opportunity Employer
- Drug-Free Workplace Act of 1988
- Accommodations for individuals with disabilities