Employer Industry: Healthcare Insurance

Why Consider this Job Opportunity:
- Competitive pay based on experience
- Opportunities for career advancement within the organization
- Work-from-home flexibility
- Comprehensive benefits package
- Supportive and collaborative work environment
- Chance to make a positive impact on member healthcare experience

What to Expect (Job Responsibilities):
- Coordinate and perform all appeal-related duties in a Medicare Advantage Plan
- Analyze and respond to appeals from members, member representatives, and providers
- Research and apply pertinent Medicare and Medicaid regulations to determine appeal outcomes
- Prepare case files for submission to Independent Review Entity
- Provide oversight and assistance to Medical Management staff with appeal resolution

What is Required (Qualifications):
- Experience in Medicare Appeals, Utilization Case Management, or Compliance in Medicare Part C
- Licensed Practical Nurse (LPN) or Registered Nurse (RN)
- 3-5 years' experience in Medicare Advantage Health Plans or related healthcare setting
- Working knowledge of Medicare Advantage, Original Medicare, and Medicaid appeal regulations
- Proficient in Microsoft Office products

How to Stand Out (Preferred Qualifications):
- Knowledge of ICD9 and ICD10 coding
- Experience in handling complex inquiries and requests for service in a healthcare setting

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