Dispute Resolution Reviewer I
Remote · United States or Austin, Texas, United States
Job Summary
Dispute Resolution Reviewer I role focuses on reviewing medical records/case files, writing clear, impartial decisions supported by medical evidence, and conducting research using federal regulations and policy to resolve enrollment denials, revocations, or suspensions. Responsibilities include addressing issues raised by beneficiaries, providers, and suppliers, ensuring fair determinations, and producing well-supported decisions within the Medicare appeals/healthcare regulatory context. Requires an associate degree (or 60+ credits towards a bachelor’s) and 1 year of relevant healthcare appeals/clinical experience; ability to work remotely within the United States is noted in the posting. Must review and apply regulations, standards, and manuals to deliver accurate, timely decisions and maintain compliance with applicable laws and policies.
Required Qualifications
- Associate's degree or 60 or more credit hours towards a Bachelor’s degree in healthcare or related discipline
- One (1) year of Medicare appeals, medical review, clinical, healthcare regulatory interpretation/application, healthcare compliance or related experience in a healthcare setting
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