What are the responsibilities and job description for the Healthcare Appeals Specialist position at TMF Health Quality Institute?
A company is looking for an Appeals Professional III (Healthcare Professional).Key Responsibilities : Reviews medical records and writes clear, concise, and impartial reconsideration / dispute resolution decisionsMakes independent decisions based on medical evidence in accordance with relevant statutes and policiesAddresses all appeal / dispute issues raised by beneficiaries, patients, representatives, and providersRequired Qualifications : Associate's degree or 60 credit hours towards a Bachelor's degree in healthcare or a related disciplineThree years of experience in medical dispute resolution or Medicare appeals in a healthcare settingExperience in writing or making medical necessity decisionsBackground in Nursing, Physical Therapy, Respiratory Therapy, or Occupational TherapyExperience with Medicare