Medicare Clinical Appeals Reviewer III

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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

• 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

• 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

• Equal Employment Opportunity Employer • Drug-Free Workplace Act of 1988 • Accommodations for individuals with disabilities