Dispute Resolution Reviewer III (Healthcare Professional)
Remote · Austin, Texas, United States
Job Summary
Dispute resolution reviewer III for healthcare, remotely based in the United States. The role involves reviewing medical records/case files, writing clear, concise, impartial reconsideration/dispute resolution decisions supported by medical evidence and applicable statutes, regulations, and policy. Responsibilities include addressing all appeal/dispute issues raised by beneficiaries/patients, representatives, and providers, conducting research using federal regulations and contract manuals, staying current with regulatory and medical practice updates, and delivering fair determinations based on current evidence and procedures.
Required Qualifications
- Education: Associate's degree or 60+ credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline
- Experience: Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or related experience in a healthcare setting
- Substitutions: Juris Doctorate or Master’s Degree in Healthcare or related discipline may be substituted for Healthcare Professional experience
- Experience: Independent dispute resolution experience preferred
- Residency: Must have resided in the United States for a minimum of three (3) years out of the last five (5) years
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