Appeals Reviewer (Remote) Jobs

Capitol Bridge, a highly reputable provider of medical review services, is seeking an exceptional Appeals Reviewer (Remote) to join our team. As an Appeals Reviewer, you will play a vital role in ensuring that Medicare Part A and Part B administrative appeals are reviewed in accordance with federal laws and regulations. You will be responsible for examining case files and decisions made by Administrative Law Judges, identifying errors in the application of law or evidence, and making recommendations for your own motion review from the Medical Appeals Council.

We offer a competitive salary range of $55,000 to $66,622, commensurate with experience, along with excellent benefits, including medical, dental, vision, 401(k) with company match, paid holidays, and PTO.

Responsibilities:

• Perform other duties as assigned by leadership.
• Collaborate with attorneys and the Medical Director to review new or complex issues, when necessary.
• Conduct in-depth reviews of ALJ decisions and case files to determine if there are errors in the application of law or evidence in accordance with Part A and Part B laws and policies.
• Manage referral caseload and update weekly referral pending report.
• Conduct research on federal law, regulations, and CMS and contractor policies.
• Communicate directly with federal government entities and contractors regarding administrative questions.
• Summarize the legal issues for submission to the Medical Appeals Council.
• Provide feedback to the review team regarding referral issues.
• Assist in the development and maintenance of written procedures for consistency of reviews and training of new personnel.
• Ensure timely reviews to meet CMS standards.

Requirements:

• Ability to perform comfortably in a fast-paced, deadline-oriented work environment.
• Strong organizational, interpersonal, written, and verbal communication skills.
• At least three years of Medicare review or appeals experience.
• Knowledge of Medicare policies and coverage issues and HCPCS coding.
• Bachelor’s degree.
• Ability to work independently and as a team member.

About Capitol Bridge:
Capitol Bridge, established in 2012, is based in Arlington, Virginia, and is an SBA 8(a) Certified Small Disadvantaged Business. We are experts in providing independent medical reviews, records/data management services, medical coding, administrative staffing, and eligibility reviews.

Reasonable Accommodation:
At Capitol Bridge, we comply with federal and state disability laws and provide reasonable accommodations for applicants and employees with disabilities. If you require a reasonable accommodation to participate in the job application or interview process, perform essential job functions, or receive other benefits and privileges of employment, don't hesitate to contact your recruiter.

EEO Statement:
Capitol Bridge is an Equal Opportunity Employer, and all employment decisions are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental, or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union, or domestic partnership status, past or present military service, family medical history or genetic information, family, or parental status, or any other status protected by the laws or regulations in the locations where we operate.

Texting Notice:
We communicate with applicants by text, in addition to email and phone. If you apply for this position, we may text you about this position, your application for the position, or other things relevant to this job position. If we text you and you no longer want us to text you, you can opt-out at that time.

Job Type: Full-time

Pay: $55,000.00 - $66,622.00 per year

Benefits:

• Vision insurance
• Paid time off
• 401(k)
• Health insurance

Schedule:

• Monday to Friday
• 8 hour shift

Work Location: Remote