Medicare Appeals Paralegal - Reimbursement & Strategy

Hall Render Killian Heath & Lyman, P.C.; Indianapolis (IN); On-site; USD 55,000 - 85,000; Full time

Job summary

Hall Render Killian Heath & Lyman, P.C. seeks a Medicare Appeals Paralegal to support its healthcare reimbursement and litigation practice. The role involves managing complex Medicare cost report appeals, reimbursement analyses, and related litigation matters under attorney supervision.

You will analyze technical reimbursement data, prepare filings, coordinate with MACs and PRRB personnel, and maintain databases and reports to support successful appeal outcomes.

Qualifications

• Knowledge of Medicare reimbursement principles, Medicare Cost Reports, PRRB appeals, and healthcare 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 interpretation
• Proficiency with Microsoft Excel, databases, and case management systems
• Experience with healthcare providers, reimbursement consultants, regulatory agencies, or healthcare litigation teams preferred
• Paralegal Certificate + five year experience preferred, but commensurate education and experience is also considered.

Responsibilities

• Assist with the technical management of Medicare Cost Report group and individual appeal matters
• 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 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
• Collect, organize, and analyze complex financial, operational, and reimbursement documentation supporting appeals
• Prepare, draft, review, and maintain appeal filings, exhibits, reports, and supporting materials
• Maintain internal databases, reimbursement tracking tools, and reporting systems
• Prepare recurring reports related to appeal activity, recoveries, and cost-sharing obligations
• Serve as a point of contact for clients regarding appeal status, analyses, strategic considerations and procedural matters
• Communicate with attorneys, healthcare providers, MACs, PRRB personnel, and other stakeholders
• Facilitate resolution of technical, financial, and regulatory issues affecting appeal matters

Skills

Communication

Writing skills

Independent work

Attention to detail

Time management

Education

Paralegal Certificate

Tools

Excel

Databases

Case management system

Job description

Hall Render Killian Heath & Lyman, P.C. seeks a Medicare Appeals Paralegal to support its healthcare reimbursement and litigation practice. The role involves managing complex Medicare cost report appeals, reimbursement analyses, and related litigation matters under attorney supervision.

You will analyze technical reimbursement data, prepare filings, coordinate with MACs and PRRB personnel, and maintain databases and reports to support successful appeal outcomes.