Medicare Appeals Reviewer I (Dispute Resolution Reviewer I)

Overview

Tanaq Support Services (TSS), a subsidiary of St. George Tanaq Corporation, an Alaskan Native Corporation, offers professional, scientific, technical, and IT services to federal health and other government agencies. Committed to supporting federal clients and the Tanaq native community, TSS seeks a Medicare Appeals Reviewer I to handle Medicare enrollment appeal and rebuttal cases.

Role Description

The Medicare Appeals Reviewer I will examine cases, assess evidence, and make independent decisions aligned with relevant laws, regulations, policies, and guidelines. This position operates under general supervision with some autonomous decision-making latitude. The position is remote and applicants must reside within the United States.

Responsibilities

• Examine medical records and case files; compose clear, concise, objective decisions justified by supporting documentation.
• Make sound and independent determinations grounded on medical evidence and applicable laws, regulations, rulings, and policies.
• Address all concerns raised by beneficiaries, representatives, suppliers, and providers comprehensively.
• Issue impartial decisions based on current evidence and regulatory standards.
• Conduct thorough research utilizing federal regulations, policy manuals, medical literature, contract documents, and other sources to ensure accurate determinations.
• Keep updated with changes in medical regulations, healthcare practices, and policies.
• Engage in special projects and other assigned tasks as needed.

Qualifications and Requirements

• Minimum of one year experience in Medicare appeals, medical review, clinical work, healthcare regulatory interpretation, compliance, or a relevant healthcare role.
• Familiarity and compliance with HIPAA and handling personally identifiable information (PII).
• Proficiency with Microsoft 365 applications including Excel and Word.
• Ability to pass required federal and state background checks as well as drug screening.
• Legal authorization to work in the U.S. without employer sponsorship now or in the future.

Preferred Skills

• Experience within federal public health agencies.
• Knowledge of appeals processes and medical billing.
• Understanding of CMS guidelines or manuals, especially relating to the No Surprises Act.
• Certification in Medical Coding is advantageous.

Education and Training

• Associate degree or completion of at least 60 credit hours toward a Bachelor's degree in healthcare or a related field from an accredited institution.
• Alternatively, relevant healthcare experience in Medicare appeals or medical review can substitute for an Associate degree on a year-for-year basis.

Physical Demands

• Extended periods of desk work using computers; occasional lifting of up to 25 pounds may be required.

Company Background

Tanaq Support Services is a health-focused federal contractor and certified 8(a) business owned by an Alaska Native Corporation. The company values stakeholder input and leverages interdisciplinary expertise to develop effective solutions.

Equal Opportunity Policy

Tanaq Support Services is committed to equal employment opportunities regardless of disability, veteran status, or other legally protected classifications. The company adheres to the Drug-Free Workplace Act and participates in E-Verify.

Accommodation and AI Usage Notice

Applicants needing assistance during the application process due to disability can request accommodations via email. The use of AI tools during interviews is prohibited unless prior accommodation arrangements are made.