Medicare Advantage Appeals Specialist: Case Coordination

Encompass Health Corporation; Birmingham (AL); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Tuition reimbursement

401(k) match

Job summary

Encompass Health Corporation in Birmingham, AL seeks a Medicare Advantage Plan Appeals Specialist to coordinate appeals for hospital patients seeking insurance coverage. You will work with patients, hospital staff, physicians, and counsel across multiple appeal levels.

Bachelor's degree required; experience in a legal setting is preferred. This role sits in the REAL department and requires accurate record-keeping, deadlines, and collaboration with leadership.

Qualifications

• Bachelor's degree required.
• Experience in a legal setting is preferred.

Responsibilities

• Understands the entire Medicare Advantage plan appeals process and CMS rules pertaining to appeals.
• Works with patients, hospital staff, and physicians to obtain all pertinent records and evidence for appeals.
• Schedules witness interviews and preparation for witness testimony.
• Reviews medical records, plan denials, and other patient records to prepare witnesses.
• Maintains statistics on MA plan appeals and provides reports to leadership.
• Prepares cases for hearings and filings with Medicare Appeals Council or other courts.
• Ensures filings are completed accurately and on time.
• Collaborates with in-house and outside counsel to coordinate caseloads and deadlines.
• Sits at our Home Office in Birmingham, AL.

Skills

Legal experience

Research skills

Communication

Teamwork

Education

Bachelor's degree

Job description

Encompass Health Corporation in Birmingham, AL seeks a Medicare Advantage Plan Appeals Specialist to coordinate appeals for hospital patients seeking insurance coverage. You will work with patients, hospital staff, physicians, and counsel across multiple appeal levels.

Bachelor's degree required; experience in a legal setting is preferred. This role sits in the REAL department and requires accurate record-keeping, deadlines, and collaboration with leadership.