Medicare Appeals Paralegal : Indianapolis

Hall Render; Indianapolis (IN); In loco; USD 70.000 - 100.000; Tempo pieno

Descrizione del lavoro

Hall Render is seeking a Medicare Appeals Paralegal to support health care reimbursement and litigation matters. You will manage complex Medicare Cost Report appeals, perform reimbursement analyses and coordinate with clients, MACs and litigation teams to drive favorable outcomes.

Responsibilities include preparing filings, analyzing cost reports and reimbursement data, communicating status to attorneys and clients, and maintaining databases and reporting tools.

Competenze

• Knowledge of Medicare reimbursement principles and Cost Reports.
• Strong analytical ability to interpret complex reimbursement data.
• Proficiency with Excel, databases and case management systems.
• Paralegal certification plus 5 years of experience preferred.

Mansioni

• Manage Medicare Cost Report appeals and related reimbursements.
• Collaborate with attorneys, MACs, PRRB and clients on filings and deadlines.
• Prepare and review appeal filings, exhibits and reports.
• Develop strategic recommendations to improve appeal outcomes.
• Conduct financial analyses and modeling for cost recovery opportunities.
• Maintain internal databases and reporting tools.
• Serve as client liaison on appeal status and regulatory matters.

Conoscenze

Effective communication

Analytical skills

Independent problem solving

Detail-oriented

Time management

Formazione

Paralegal Certificate

Experience preferred

Strumenti

Excel

Databases

Case management systems

Descrizione del lavoro

The Medicare Appeals Paralegal serves as a subject matter expert supporting the Firm’s health care reimbursement and litigation practice by managing complex Medicare cost report appeals, reimbursement analyses and related litigation matters. The Medicare Appeals Paralegal independently manages routine case actions for the appeals, analyzes highly technical reimbursement issues, develops strategic recommendations and coordinates with clients, regulatory agencies and litigation teams to ensure successful case outcomes.

• Assist with the technical management of Medicare Cost Report group and individual appeal matters
• Continually collaborate with attorneys regarding filing requirements, procedural deadlines and regulatory compliance obligations to ensure timely submissions
• Analyze Medicare cost reports, reimbursement calculations/trends, payment methodologies, regulatory developments and supporting financial data
• Calculate and validate Amounts in Controversy ("AIC") and other reimbursement metrics required for appeals
• Identify and communicate procedural issues, risks and opportunities that may impact appeal outcomes and recommend appropriate actions
• Perform financial modeling and cost-benefit analyses to evaluate appeal viability and potential recovery opportunities
• Develop recommendations regarding appeal participation and reimbursement recovery opportunities

Documentation & Reporting

• Collect, organize and analyze complex financial, operational and reimbursement documentation supporting appeals
• Prepare, draft, review and maintain appeal filings, exhibits, reports and supporting materials, ensuring accuracy, completeness and consistency
• Maintain internal databases, reimbursement tracking tools and reporting systems
• Prepare recurring reports related to appeal activity, recoveries and cost-sharing obligations

Client & Stakeholder Relationship Management

• Serve as a point of contact for clients regarding appeal status, reimbursement analyses, strategic considerations and procedural matters
• Communicate directly with attorneys, health care providers, Medicare Administrative Contractors ("MACs"), PRRB personnel and other stakeholders
• Facilitate resolution of technical, financial and regulatory issues affecting appeal matters

Primary Competencies:

• Ability to effectively communicate complex details to clients and stakeholders
• Excellent writing, grammar and proofreading skills
• Ability to work independently to find solutions to technical problems
• Detail-oriented with strong organizational and time management skills
• Ability to make recommendations and/or decisions in a fast-moving environment

Knowledge, Skills, Experience & Education:

• Knowledge of Medicare reimbursement principles, Medicare Cost Reports, PRRB appeals and health care regulatory requirements
• Strong analytical skills with the ability to interpret complex reimbursement data
• Ability to exercise independent judgment and develop recommendations based on technical analysis and regulatory interpretationProficiency with Microsoft Excel, databases and case management systems.
• Experience working with health care providers, reimbursement consultants, regulatory agencies or health care litigation teams preferred
• Paralegal Certificate + five years of experience preferred, but commensurate education and experience is also considered.

Travel and Physical Requirements

• Limited travel
• Prolonged periods of sitting at a desk and working on a computer
• Frequent use of hands and fingers for typing, writing and operating office equipment
• Occasional standing, walking, bending and reaching
• Ability to lift and carry up to 10–15 pounds (e.g., files, documents, office supplies)
• Visual acuity to read screens, review documents and analyze detailed information
• Ability to communicate effectively via phone, video and in person

NOTE: This job description covers essential job duties and requirements is not intended to be all-inclusive. Employee may perform other related duties as required to meet the ongoing needs of the Firm.

Hall Render was founded on a tradition of excellence, has never wavered from this tradition, and continues to search for ways to raise its own standard.