The Medicare Appeals Staff Attorney will review Medicare Part A and B administrative appeals decisions; identify the legal, factual and policy issues to be addressed in Medicare appeals; research federal statutes and regulations and Medicare policy; and prepare legal memoranda supporting Medicare’s position.
The incumbent will also coordinate with other Medicare contractors and the Centers for Medicare and Medicaid Services (CMS) to advise on the interpretation and application of Medicare laws and policies; identify vulnerabilities in Medicare policy; and develop strategies to promote accurate and consistent adjudications.
The position requires subject matter expertise in Medicare law and policy or the ability to learn quickly. Qualified candidates must have a Juris Doctor degree and demonstrate excellent research and writing skills. The ability to build and maintain constructive relationships with management, Medicare contractors and CMS is essential.
JOB RESPONSIBILITIES:
· Review Medicare administrative appeals decisions and identify the legal, factual and policy issues to be addressed in Medicare administrative appeals.
· Research issues and prepare legal memoranda supporting Medicare policy.
· Evaluate appeals decisions, advise on the interpretation and application of Medicare laws and regulations, and provide strategies to promote consistency in the appeals process.
· Ensure that the memoranda are distributed to appropriate parties as required by regulations and client contract.
· Coordinate with the Centers for Medicare and Medicaid Services (CMS) and Medicare contractors to identify vulnerabilities to Medicare law and policy provide strategies to promote consistency in the appeals adjudications.
· Demonstrate teamwork and promote positive company relations.
· Assist in the development and maintenance of written procedures for consistency of reviews and quality improvement.
· Perform special projects and other duties as assigned.
EDUCATION/EXPERIENCE:
Juris Doctor degree
SKILLS/KNOWLEDGE REQUIRED:
· Demonstrated excellent research and writing skills
· Subject matter expertise in Medicare law and policy or the ability to learn quickly
· Proficiency with Microsoft Word and Excel
· Ability to maintain confidential and sensitive information
COMMENTS
This position involves chiefly researching and writing. Writing samples must be available upon request. Experience with Medicare or related healthcare law is preferred but not required. Preferred location to be EST or CST time zones.