Appeals Professional III (Weekend Work)

Job description

*This position is working weekends - includes both Saturday and Sunday* *This is a part-time position* **Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.** *This position is located Remote United States* Position Purpose: Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Essential Responsibilities: - Reviews medical records/case file, writes a reconsideration decision letter 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 appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed. - Provides a fair a...