General

• Coordinate the Medicare Advantage appeals process for claims involving insurance coverage for hospital stays
• Work with patients, hospital personnel, physicians, in-house counsel, and outside counsel throughout multiple appeal levels
• Obtain pertinent records and evidence for appeals
• Schedule witness interviews and witness-testimony preparation
• Review acute hospital medical records, plan denials, and patient records to prepare witnesses
• Ensure appellate administrative records are complete and submitted to courts, Medicare Advantage plans, and opposing counsel
• Maintain statistics on Medicare Advantage appeals and provide leadership reports
• Prepare cases for hearings and coordinate case assignments with in-house and outside counsel
• Assist with preparing and filing appeals to the Medicare Appeals Council and other courts of jurisdiction
• Complete filings and review hospital filings for accuracy; assist hospitals with corrections
• Monitor and report on administrative hearings
• Ensure filing deadlines are met
• Work with hospital and Home Office leadership to resolve issues and escalate appropriately
• Retain documents in relevant electronic data systems
• Collaborate with team members and share information, best practices, and resources

EHC

Medicare Advantage Plan Appeals Specialist