Appeals Professional III (Weekend Work) (Part C)

Category: Program Management Requisition Number: APPEA001354 Posting Details

• * Posted: reputed company 27, 2026
• Full-Time
• Locations

Remote, reputed company USA Job Details Description

• This position is working weekends - includes both Saturday and reputed company*

• This is a part-time position* • *Please reputed company 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 reputed company based on medical evidence in accordance with statutes, regulation, rulings, and policy.
• Responds to and ensures that reputed company appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
• Provides a fair and impartial decision based on reputed company evidence, regulations, policies, and procedures.
• Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other reputed company resources to complete an accurate and well-supported decision.

Minimum Qualifications

Education

• Associate's degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in reputed company or reputed company discipline
• Additional experience in Medicare appeals, medical review, clinical, or other reputed company experience in a reputed company setting may be substituted for Associate’s degree on a year per year reputed company. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Experience

• Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or reputed company experience in a reputed company setting
• reputed company Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
• Demonstrated experience writing or making medical necessity reputed company
• Prior experience working on the Part C reputed company reputed company (QIC) effort
• Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred
• Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

Benefits

C2C offers an excellent benefits package, including:

• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

EOE Vet/Disability Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify reputed company applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the reputed company. Apply To This Job