Appeal Officer / Health Care Attorney (Remote) Maximus Federal
This position will support clinical consulting service programs for state clients with long term relationships with Maximus – including the California Department of Managed Health Care and California Department of Insurance. Programs cover multiple subject areas including benefit coverage disputes, billing disputes, fraud and abuse, and medical consulting. This position involves purely transactional work. It does not involve any litigation.
This is an exciting opportunity to join our team!
The Appeal Officer (Health Care Attorney) will conduct careful analysis of medical records and expert reviewer findings to assess eligibility for coverage and ensure the appropriate determination is reached.
Primary Responsibilities:
Review cases to identify and summarize key facts of each case assigned and assess medical and legal issues involved in the case
Research issues using California law, California regulations, relevant contract law and other sources as defined by the client contract
Identify and request relevant medical records as needed
Communicate the determination in a clearly written format
Exercise independent judgment to ensure determination is accurate, well-supported and defensible.
Minimum Qualifications:
Significant experience in Health Care Appeals, Pharmacy Claims or other related fields
Ability to successfully execute many complex tasks simultaneously
Ability to respond to the needs of outside contacts
Working knowledge and use of PC, claim adjudication, MS Word and Excel software, and appeals system software
Must be able to work as a part of a team as well as independently, and promote positive company relations
Excellent organizational, interpersonal, written and verbal communication skills
JD Required
Familiarity with medical terminology and medical record review preferred
Familiarity with California health care law/Knox Keene Act and managed health care preferred
Remote Assignment Requirements:
Conduct daily activities and supervisor communications as if the employee were in an office location
Must be accessible by phone, e-mail, IM, or voice mail within a reasonable time period during the agreed-upon work schedule
Check e-mail, voice mail, and IM for updates throughout the agreed-upon work schedule timeframe
Other members of the Remote Worker’s family and visitors to the Remote Worker’s home may not use Maximus equipment
Make appropriate work arrangements that maintain separation between the employee’s private life and business activities
An established and demonstrated safe and quiet home work environment (as defined by the Remote Worker PI Policy and the Remote Worker Privacy and Security Checklist)
Ability to use and maintain reliable internet service (Broadband/Cable internet is recommended with 80 megabits download capability)
Minimum Requirements:
– Bachelor’s Degree from an accredited college or university.
– 3-5 years of related experience.
MAXIMUS Introduction
Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs.
With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.
EEO Statement
EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country.
We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.
Pay Transparency
Maximus compensation is based on various factors including but not limited to a candidate’s education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus’s total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation shall be commensurate with job duties and relevant work experience. An applicant’s salary history will not be used in determining compensation.
