Medicare Appeals Reviewer I – Dispute Resolution Reviewer I

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Tanaq Government Services, LLC

WebsiteLinkedInAll Job Openings

2 - 10 employees

Founded 2016

🏛️ Government

📦 Logistics

🏥 Healthcare

Government • Logistics • Healthcare

Tanaq Government Services, LLC is a wholly owned subsidiary of St. George Tanaq Corporation (an Alaska Native Corporation) and an SBA 8(a) certified small business based in Anchorage, Alaska. Tanaq has two business units: Base Operations Support (BOS), which provides facilities and base-support services including electrical, plumbing, HVAC, mechanical work, preventative/predictive maintenance, facilities management, general maintenance, aviation maintenance, inventory and asset management, purchasing, and shipping/receiving/storage; and Tanaq Health, which offers administrative and professional support, health science services, data management, and staff augmentation. TGS focuses on delivering compliant, efficient, and economical support services to government and institutional clients.

📋 Description

• 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

• 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

• Health insurance • Flexible work arrangements • Paid time off