Medicare Advantage Plan Appeals Specialist

Join us on the heart-warming journey with a team that is a top leader in the rehabilitation industry

Encompass Health is the leader in the inpatient rehabilitation industry, you’ll feel the Encompass Health difference as soon as you join. We collaborate and provide high-quality, compassionate, individualized care for our patients, allowing us time to get to know them and help them achieve their goals during their rehabilitation journey. 

Position Purpose

The Medicare Advantage (MA) Plan Appeals Specialist coordinates the Medicare Advantage appeals process for claims made by hospital patients seeking insurance coverage for their hospital stays. The Specialist works with hospital patients, hospital personnel, physicians, in-house counsel, and outside counsel throughout the multiple levels of the appeals process.  The Specialist is a member of the Regulatory Enrollment, Approvals & Licensure (REAL) Department. 

RESPONSIBILITIES AND TASKS

• Understands the entire Medicare Advantage (MA) plan appeals process and CMS rules pertaining to appeals.

• Works with patients, hospital staff, and physicians to obtain all pertinent records and evidence for appeals. 

• Schedules witness interviews and preparation for witness testimony.

• Reviews acute hospital medical records, plan denials, and other patient records to prepare witnesses.

• Ensures appellate administrative records are complete for all cases and have been submitted to the appropriate court, MA plans, and opposing counsel. 

• Maintains statistics on all MA plan appeals and provides reports as requested by leadership.

• Works with in-house and outside counsel to prepare cases for hearings, coordinate case assignments, and assist with the preparation and filing of appeals to the Medicare Appeals Council or other courts of jurisdiction. 

• Understands how to complete various filings and reviews hospital filings to ensure accuracy.  Assists hospitals in correcting filings, as necessary.

• Monitors and reports on all administrative hearings related to assigned appeals. 

• Understands the necessary filing timelines and ensures that all deadlines are met.

• Works with hospital and Home Office leadership to resolve issues.

• Escalates issues appropriately. 

• Conducts independent research accurately and efficiently.

• Retains all documents using the relevant electronic data systems.

• Responsibly and securely stores confidential information and protected health information. 

• Collaborates with team members, sharing information, best practices, and resources with peers.

• This position must sit at our Home Office in Birmingham, AL  
   

Minimum Qualifications:

• Bachelor’s degree required. 

• Experience in a legal setting is preferred.

A little about us

We’re confident you’ll see the difference the moment you join our team. Working at Encompass Health means working with a growing national inpatient rehabilitation leader. We’re proud of our career growth opportunities and how our team members work together for the greater good of our patients. We’ve been named one of the “World’s Most Admired Companies” and a Fortune 100 Best Companies to Work For® Award, among others, which is pretty amazing. 

Our benefits start day one

• 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) and employee stock purchase plans.

• Flexible spending and health savings accounts.

• A community of people who love what they do. Yes, we see that as a benefit.

The Encompass Health Way We proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!    At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.