Appeals Professional II

Appeals Professional II Fully Remote-United States Job Type Full-time Description Overview Tanaq Support Services ( TSS ) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in health, agriculture, technology, and other government services. TSS is a subsidiary of the St. George Tanaq Corporation, an Alaskan Native Corporation ( ANC ) committed to serving Federal customers while also giving back to the Tanaq native community and shareholders. About the Role We are seeking an Appeals Professional II to support a contract with our federal client. Performs complex work. Provides dissatisfied beneficiaries and/or providers the opportunity to present documentation or evidence to demonstrate why an appeal or rebuttal for an enrollment denial, revocation, or suspension should be allowed. Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. This is a remote position that can be based anywhere in the United States. Must be able to work on a rotating schedule on weekends and holidays. Responsibilities + Responsible for significant or complex programs, may assist with quality reviews and audits. + Reviews medical records/case file, writes a decision that is clear, concise, and impartial and supports the determination made, and documents review. + Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, and policy. + Responds to and ensures that all issues raised by the beneficiary, representative, supplier, and provider have been addressed. + Provides a fair and impartial decision based on current 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 related resources to complete an accurate and well-supported decision. + Stays abreast of changes in regulations, medical and healthcare practices, policies and procedures. + Participates in special projects and performs other duties as assigned. Requirements Required Skills and Experience + Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or related experience in a healthcare setti To view full details and how to apply, please login or create a Job Seeker account