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Paralegal, Medicare Appeals (Remote)
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Overview 

Our client is seeking a detail-oriented Paralegal with experience in healthcare regulations to support its work with the Centers for Medicare & Medicaid Services (CMS) Office of Hearings. This is an exciting opportunity to contribute to the administration of fair and independent Medicare RADV appeals in a collaborative, mission-driven environment. The ideal candidate will bring a minimum of three years of paralegal experience, preferably within healthcare regulatory compliance, with demonstrated expertise in Medicare regulations and legal document preparation. 

 

About the Organization 

Our client is a leading provider of specialized administrative and legal support services for healthcare organizations. Currently supporting CMS Office of Hearings, they focus on Risk Adjustment Data Validation (RADV) appeals processes, ensuring fair, accurate, and efficient hearings in support of healthcare providers nationwide. 

 

Why Join the Team? 

  • Workplace Flexibility – Fully Remote with a 37-hour work week! 
  • Competitive Compensation – A salary package that reflects your experience and qualifications 
  • Comprehensive Benefits – Medical, dental, and vision coverage, alongside a 401(k) plan with profit sharing 
  • Paid Time Off – PTO, holidays, bereavement, and parental leave, plus resources focused on health and well-being 
  • Professional Growth – A collaborative, team-based work environment with opportunities for long-term career advancement 

 

Key Responsibilities 

  • Review and analyze appeal requests and supporting documentation for completeness, timeliness, jurisdiction, and standing 
  • Identify and categorize motions, objections, and preliminary legal matters 
  • Process and track appeals throughout their lifecycle using the Office of Hearings Case and Document Management System (OH CDMS) 
  • Schedule and coordinate pre-hearing conferences and hearings (record, virtual, and in-person) 
  • Prepare notices, correspondence, and other required documentation 
  • Attend pre-hearing conferences and hearings to document proceedings 
  • Draft legal memoranda with analysis and recommendations for hearing officers 
  • Research and apply relevant regulations, particularly 42 CFR § 422.311 
  • Draft proposed decisions addressing appealed issues with appropriate legal citations 
  • Maintain electronic case files and documentation in compliance with CMS requirements 
  • Support development and refinement of Standard Operating Procedures (SOPs) 

 

Qualifications & Experience 

  • Bachelor’s degree in paralegal studies, legal studies, or related field is required 
  • Minimum 3 years of paralegal experience, preferably in healthcare regulatory compliance 
  • Knowledge of Medicare regulations and healthcare coding practices 
  • Experience with case management systems and legal document preparation 
  • Strong analytical and legal research skills 
  • Excellent writing abilities, particularly for legal documents and memorandums 
  • Meticulous attention to detail with strong organizational skills 
  • Ability to track multiple deadlines and manage competing priorities 

 

Preferred Qualifications 

  • Paralegal certification 
  • Experience with Salesforce or similar case management systems 
  • Knowledge of CMS-HCC risk adjustment model 
  • Familiarity with medical coding and documentation requirements 
  • Prior experience with administrative hearing processes 

 

Take the Next Step 

If you are a detail-oriented and experienced Medicare Appeals Paralegal ready to advance your career, we encourage you to apply today. Join a team committed to supporting fair hearings and making a meaningful impact in healthcare administration. 

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