Medicare Appeals Staff Attorney (Remote)

Job Overview  

As the Administrative Qualified Independent Contractor for Medicare Parts A and B, one of our tasks is to review claim decisions by Administrative Law Judges (ALJs) for errors and, when appropriate, to recommend that the next level of appeal, the Medicare Appeals Council, take own motion review of an ALJ’s decision. The Medicare Appeals Council is the final level in the administrative review process for Medicare claims.  

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.

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 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.

Qualifications

· Juris Doctor degree required

· Candidates in EST/CST time zones required

· Demonstrated excellent research and writing skills required

· Subject matter expertise in Medicare law and policy or the ability to learn quickly required

· Proficiency with Microsoft Word and Excel required

· Ability to maintain confidential and sensitive information required

Salary Range: $68,000 – $72,000 per year, depending on experience and qualifications

Reasonable Accommodation

If you require alternative methods of application or screening, you must approach the employer directly to request this. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

EEO Statement

Capitol Bridge LLC is an Equal Opportunity Employer. All employment decisions at Capitol Bridge LLC 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

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