Medicare Appeals Specialist Position

6 days ago


Chadds Ford, Pennsylvania, United States Hueman PE Talent Solutions Full time

Unlock a Rewarding Career with Hueman PE Talent Solutions

We are seeking an experienced Medicare Appeals Specialist to join our team at Hueman PE Talent Solutions in Chadds Ford, PA.

About the Role:

The successful candidate will be responsible for reviewing Medicare denial notices, analyzing patient cases, gathering necessary documentation, and submitting claims for Medicare appeals. They will also assist with all aspects of the appeals process, ensuring seamless communication across departments.

Key Responsibilities:

  • Conduct thorough reviews of Medicare claim denials to identify potential issues and opportunities for appeal.
  • Analyze patient records to ensure accuracy and completeness, making any necessary updates to maintain precise data.
  • Prepare and submit audit claims for various levels of review, including ALJ hearings, to advocate for patients' rights.
  • Maintain detailed audit sheets according to company procedures to track progress and identify areas for improvement.
  • Update the company's patient database (MSS) on all case activity to ensure timely and informed decision-making.
  • Provide regular feedback to Team Leaders on appeal status, suggesting strategies for improvement.
  • Prepare and submit Medicare RAC, TPE, and CERT reviews and audits to facilitate efficient and effective resolution.
  • Support special projects as required, working collaboratively with other employees, managers, and departments.
  • Perform all job functions with Company Mission, Vision, and Goal Statements guiding decisions and actions.

Requirements and Qualifications:

To succeed in this role, you should possess:

  • A high school diploma or equivalent; 2-3 years of relevant industry experience or equivalent combination of education and experience preferred.
  • Proficiency in basic to intermediate mathematical concepts (fractions, percentages, ratios, and statistical inference) to support job functions.
  • Proficient computer skills, including word processing, spreadsheets, and database management, with the ability to learn company-specific software quickly.
  • Strong analytical skills to interpret complex data and develop logical solutions where limited guidance exists.
  • Excellent interpersonal and communication skills to read and interpret business and technical information, write reports and procedures, and communicate effectively across the organization.
  • Able to work in a standard office setting using standard equipment, maintaining sustained attention to detail, stamina, and manual dexterity for various office tasks.
  • Able to maintain productivity and judgment in a fast-paced environment with occasional schedule adjustments as needed.
  • Ability to work independently, manage time effectively, and handle interruptions with professionalism.

About Our Company:

Hueman PE Talent Solutions is dedicated to providing exceptional home compression therapy products, serving patients worldwide with lymphedema, venous insufficiency, and lipedema. As a certified Great Place to Work and recognized top employer by Philly Top Workplaces and Fortune Magazine, we strive to create a supportive and dynamic work environment.

Estimated Salary Range: $65,000 - $85,000 per year, depending on experience and qualifications. We offer competitive compensation and benefits packages, reflecting our commitment to attracting and retaining talented professionals like you.



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