Medicare Advantage Plan Appeals Specialist

EHC

. Coordinate the Medicare Advantage appeals process for claims involving insurance coverage for hospital stays .

Posted 9/29/2026full-timeBirmingham • Alabama • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in coordinating the Medicare Advantage appeals process, including the preparation and review of legal filings and administrative records. Proficient in collaborating with healthcare professionals and legal counsel while ensuring compliance with CMS rules and filing deadlines.

Highest-signal resume keywords

Medicare Advantage Appeals ProcessLegal Filings PreparationMedical Records ReviewConfidential Information HandlingIndependent Research

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Applicant Tracking System Keywords

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Hard Skills

Bachelor’s DegreeUnderstanding of CMS RulesReview of Plan DenialsPreparation of Witness TestimoniesStatistical ReportingFiling AccuracyCase CoordinationDocument RetentionDeadline ManagementEvidence Collection

Soft Skills

CollaborationCommunicationProblem-SolvingLeadership

Tools & Technologies

Electronic Data Systems

Industry Keywords

Medicare AdvantageHealthcare AppealsLegal SettingPatient RecordsHospital Personnel

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

Bachelor’s degree required
Experience in a legal setting is preferred
Understanding of the Medicare Advantage appeals process and CMS rules pertaining to appeals
Ability to work with patients, hospital staff, physicians, in-house counsel, and outside counsel
Ability to obtain and review medical records, plan denials, and patient records
Ability to prepare and review legal filings and administrative records
Ability to meet filing timelines and deadlines
Ability to conduct independent research accurately and efficiently
Ability to securely handle confidential information and protected health information
Must sit at the Home Office in Birmingham, AL

Benefits

Comp & perks

Affordable medical, dental and vision plans for full-time and part-time employees and their families
Generous paid time off that accrues over time
Tuition reimbursement and continuing education opportunities
Company-matching 401(k)
Employee stock purchase plans
Flexible spending accounts
Health savings accounts
Inclusive culture and equal employment opportunities
Career growth opportunities