Providing independent second-level determinations, the full-time Remote Appeals Specialist will review medical records, write reconsideration decision letters, and ensure all appeal issues are addressed in compliance with regulations and policies. Key responsibilities Review medical records and case files, documenting findings and writing clear and concise decision letters Make independent decisions based on medical evidence and relevant regulations Conduct research on federal regulations and medical practices to support accurate decision-making Required qualifications Associate's degree or 60+ credit hours in healthcare or a related discipline, or equivalent experience in Medicare appeals Three years of experience in medical dispute resolution or related healthcare settings Experience in writing medical necessity decisions or managing Medicare appeals Background as a healthcare professional, such as Nursing, Physical Therapy, or Occupational Therapy Residency in the United States for at least three of the last five years