Providing independent second-level determinations, the full-time Licensed Appeals Professional will review medical records and write clear, impartial decisions on appeals and disputes while working remotely. Key responsibilities Reviews medical records and writes clear reconsideration/dispute resolution decisions Makes independent decisions based on medical evidence in accordance with relevant regulations and policies Conducts research on federal regulations and medical practices to support accurate decision-making Required qualifications Associate's degree or 60+ credit hours towards a Bachelor's degree in healthcare or related discipline Three years of experience in medical dispute resolution or Medicare appeals in a healthcare setting Experience in writing medical necessity decisions Preferred experience in Medicare Part A Appeals or related healthcare coding Resided in the U.S. for at least three of the last five years