Reconsideration Professional Required to Work From Home

Reconsideration Professional Required to Work From Home

Job Description

Mainly to provide denovo independent second level determination of  granting an appeal based on facts, regulations, guidelines and laws relating to documents as presented by dissatisfied beneficiaries. Candidate should be capable of making incontrovertible decisions based on medical evidence keeping in mind rulings, statutes, regulations and policies of Centers for Medicare & Medicaid Services and local Medicare. Candidates also need to address all issues related to appeals as raised by the beneficiary, supplier and/or representative and arrive at a fair and impartial decision in each case. Job duties also entail research using online regulation in the context of accurate and well-supported decisions, keep abreast with changes in medical practices and procedures, constant upgradation of knowledge base to support decision making and retain as well as apply knowledge to cases. Candidates need to communicate with internal and external customers, identify and resolve issues or refer them, assure regulatory compliances and maintain extreme confidentiality in conformity with laid down procedures. Candidates also need to participate in projects and take on other assigned duties.


Capability to concentrate and stay focused; handle computers with ease, email, collaborate as a team player, make crucial decisions impartially, prepare and write notes; work independently, adhere to deadlines, interface with public, achieve company’s objectives and vision, be physically and mentally fit, own and operate a vehicle and travel when required, with overnight stay.

Qualifications and Experience

High School Diploma; Licensed healthcare professional or licensed practical nurse with five years experience in handling Medicare appeals in a decision making situation with 3 years clinical or 5 years in Medicare appeals.

 This work at home position offers excellent pay and benefits including 125 plan, 401K plan, license credential reimbursement.

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