Medicare Appeals Specialist Jobs in New York

·Strong interpersonal, time management and organizational skills.

·Effective multi-tasking skills in a high-volume environment.

·Excellent written and verbal communication skills.

·Certification as a MSCC, CMSP, CLCP or CNLCP, preferred.

·Understand and apply evidence based medical treatment guidelines, and/or CMS guidelines to future care recommendations.

·Identify and outline Medicare and Non-Medicare covered treatment.

Stay abreast of regulatory updates and/or new requirements and understand overall impact to day to day work

3+ years experience in BSA/AML or Fraud related work, preferably in the payments space

Strong investigative skills, including familiarity with public record research and database tools

Demonstrated transaction analysis skills that apply across numerous financial products in complex scenarios

Proven working experience as a Compliance Specialist

4+ years relevant experience in BSA/AML and Sanctions related work

Relevant Work Experience, Knowledge, Skills, and Abilities

Extensive knowledge and experience in claims, enrollment, benefits, and member contracts. (R)

Excellent prioritizing, organizing, time management, problem solving and analytical skills. (R)

Provide recommendations to management regarding issue resolution, root cause analysis and best practices.

Additional related experience/specialized training may be considered in lieu of degree requirements. (R)

Exceed median production and compliance standards for both case resolution and data requirements.