Medicare Appeals Paralegal

Key Roles and Responsibilities:

Medicare Reimbursement Analysis

• Assist with the technical management of Medicare Cost Report group and individual appeal matters
• Continually collaborate with attorneys regarding  filing requirements, procedural deadlines and regulatory compliance obligations to ensure timely submissions
• Analyze Medicare cost reports, reimbursement calculations/trends, payment methodologies, regulatory developments and supporting financial data
• Calculate and validate Amounts in Controversy (“AIC”) and other reimbursement metrics required for appeals
• Identify and communicate procedural issues, risks and opportunities that may impact appeal outcomes and recommend appropriate actions
• Perform financial modeling and cost-benefit analyses to evaluate appeal viability and potential recovery opportunities
• Develop recommendations regarding appeal participation and reimbursement recovery opportunities

Documentation & Reporting

• Collect, organize and analyze complex financial, operational and reimbursement documentation supporting appeals
• Prepare, draft, review and maintain appeal filings, exhibits, reports and supporting materials, ensuring accuracy, completeness and consistency
• Maintain internal databases, reimbursement tracking tools and reporting systems
• Prepare recurring reports related to appeal activity, recoveries and cost-sharing obligations

Client & Stakeholder Relationship Management

• Serve as a point of contact for clients regarding appeal status, reimbursement analyses, strategic considerations and procedural matters
• Communicate directly with attorneys, health care providers, Medicare Administrative Contractors (“MACs”), PRRB personnel and other stakeholders
• Facilitate resolution of technical, financial and regulatory issues affecting appeal matters

Primary Competencies:

• Ability to effectively communicate complex details to clients and stakeholders
• Excellent writing, grammar and proofreading skills
• Ability to work independently to find solutions to technical problems
• Detail-oriented with strong organizational and time management skills
• Ability to make recommendations and/or decisions in a fast-moving environment

Knowledge, Skills, Experience & Education:

• Knowledge of Medicare reimbursement principles, Medicare Cost Reports, PRRB appeals and health care regulatory requirements
• Strong analytical skills with the ability to interpret complex reimbursement data
• Ability to exercise independent judgment and develop recommendations based on technical analysis and regulatory interpretation
• Proficiency with Microsoft Excel, databases and case management systems.
• Experience working with health care providers, reimbursement consultants, regulatory agencies or health care litigation teams preferred
• Paralegal Certificate + five years of experience preferred, but commensurate education and experience is also considered.

Travel and Physical Requirements:

• Limited travel
• Prolonged periods of sitting at a desk and working on a computer
• Frequent use of hands and fingers for typing, writing and operating office equipment
• Occasional standing, walking, bending and reaching
• Ability to lift and carry up to 10–15 pounds (e.g., files, documents, office supplies)
• Visual acuity to read screens, review documents and analyze detailed information
• Ability to communicate effectively via phone, video and in person

NOTE: This job description covers essential job duties and requirements is not intended to be all-inclusive. Employee may perform other related duties as required to meet the ongoing needs of the Firm.