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Top 35 Appeals Officer Skills

Below we've compiled a list of the most important skills for an Appeals Officer. We ranked the top skills based on the percentage of Appeals Officer resumes they appeared on. For example, 17.5% of Appeals Officer resumes contained Medicare as a skill. Let's find out what skills an Appeals Officer actually needs in order to be successful in the workplace.

These are the most important skills for an Appeals Officer:

1. Medicare

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high Demand
Here's how Medicare is used in Appeals Officer jobs:
  • Make reconsideration determinations for disputes between Medicare beneficiaries or providers and Medicare Affiliated Contractors / Quality Improvement Organizations.
  • Adjudicated coverage determination disputes between Medicare recipients and Medicare Managed Care Plans.
  • Researched issues covered by federal, state and Center of Medicare Services policies via Internet and hard copy tools.
  • Performed reconsideration reviews on an as needed basis for the Medicare Part A QIC project.
  • Reviewed English and Spanish Medicare Part D Late Enrollment Penalty Appeals.
  • Collaborated with legal and medical professionals to determine Medicare benefits and eligibility Adjudicated Medicare disputes and drafted Medicare appeal decision letters
  • Make reconsideration determinations for disputes between beneficiaries regarding Medicare Part A and Part D- Late Enrolment Penalties claims.
  • Researched and adjudicated enrollee appeals from Medicare Part C health plans located across the United States.
  • Reviewed Medicare appeal claims Performed research on regulations, laws and policy governing Medicare Drafted decisions on claims

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2. Administrative Hearings

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high Demand
Here's how Administrative Hearings is used in Appeals Officer jobs:
  • Scheduled and participated in 40 + administrative hearings per week.

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3. Ensure Compliance

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high Demand

4. State Regulations

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5. Veterans

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high Demand
Here's how Veterans is used in Appeals Officer jobs:
  • Interview veterans to gather claim related information according to established policy and procedures.
  • Maintained up-to-date knowledge of trends and changes in laws and regulations to better represent claimants and veterans.
  • Case management of over 600 veterans, assisting them throughout the entire claims and appeals adjudication process.
  • Managed budget, prepared marketing materials and led workshops with over 100 women veterans in attendance.
  • Adhere to state and federal policies, procedures and guidelines always being compliant while assisting veterans.
  • Obtained favorable decisions in favor to veterans amounting to 6 million dollars in compensation quarterly.
  • Provided assistance to veterans during their appeals claim's process.
  • Reviewed and maintained files for veterans and their dependents.
  • Analyze veterans information to ascertain reasons for interruption of benefits and when feasible, have benefits reinstated.

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6. CMS

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high Demand
Here's how CMS is used in Appeals Officer jobs:
  • Researched and applied federal statutes and CMS policies to each case in order to make the correct determination.
  • Research current State/Medicare regulations and Center of Medicare and Medicare Services (CMS) program guidelines.
  • Worked as a sub-contractor to CMS.

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7. Audit Procedures

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high Demand

8. IRS

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high Demand
Here's how IRS is used in Appeals Officer jobs:
  • Cultivate and maintain close collaboration and coordination with Veteran's Affairs (VA) key officials throughout the department.
  • Spearheaded the Colorado Conservation Easement program that had no legal precedent for the Denver IRS Appeals office.
  • Lectured to professional organizations, and taught continuing education courses to IRS employees.
  • Review the taxpayer case file forwarded to IRS Appeals Division from Compliance.

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9. Law Enforcement

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high Demand

11. Appeals Process

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Here's how Appeals Process is used in Appeals Officer jobs:
  • Led the development of the appeals process for new project.
  • Handled the Appeals process for military insurance claims.
  • Directed appeals process through the university system.

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12. Administrative Appeals

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Here's how Administrative Appeals is used in Appeals Officer jobs:
  • Drafted opinions in administrative appeals arising from program activities of designated agencies in accordance with the APA.

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13. Independent Physician Consultants

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Here's how Independent Physician Consultants is used in Appeals Officer jobs:
  • Identified case requirements and issues for review by independent physician consultants.
  • Outlined pertinent facts and issues for review by independent physician consultants.

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14. Appeal Officer

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15. Tax Court

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Here's how Tax Court is used in Appeals Officer jobs:
  • Reviewed Tax Court, US Court of Appeals and Supreme Court cases in determinations.
  • Served as an expert witness in two Tax Court cases.

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16. Counsel

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Here's how Counsel is used in Appeals Officer jobs:
  • Identified, proposed, and then submitted to trial counsel precedent setting cases.
  • Prepared Notices of Deficiency (90 Day Letters) for Area Counsel.
  • Interviewed and counseled clients concerning all veterans benefit entitlement programs.

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17. Medicaid

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average Demand
Here's how Medicaid is used in Appeals Officer jobs:
  • Reconsidered determination for disputes between Medicare and Medicaid beneficiaries.
  • Make reconsideration determinations for disputes between enrollees and Medicare Part D Plans, and Medicaid.

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18. Hipaa

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average Demand

19. Medical Necessity

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average Demand
Here's how Medical Necessity is used in Appeals Officer jobs:
  • Performed medical necessity reviews for Inpatient admission and outpatient rehabilitation Medicare appeals.

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20. Court Hearings

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21. Federal Contract Compliance

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low Demand

22. Federal Courts

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low Demand

23. Nso

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low Demand
Here's how Nso is used in Appeals Officer jobs:
  • Audit enrollee records of financial sponsors (statewide).

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24. Relevant Contract Law

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low Demand
Here's how Relevant Contract Law is used in Appeals Officer jobs:
  • Researched issues using federal law, federal regulations, relevant contract law and other sources as defined by the client contract.
  • Research issues involving federal regulations, and relevant contract law as established by Medicare.
  • Researched issues of federal law, Medicare regulation and relevant contract law.

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25. Research Issues

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low Demand

26. Client Contracts

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low Demand

27. BVA

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low Demand

28. Additional Information

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low Demand

29. Applicable Regulations

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low Demand

30. Military Personnel

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low Demand

31. Staff Members

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low Demand
Here's how Staff Members is used in Appeals Officer jobs:
  • Team leader, trained and developed skills of staff members.

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32. Appropriate Parties

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low Demand
Here's how Appropriate Parties is used in Appeals Officer jobs:
  • Issued The Determination in a concise report to all appropriate parties as required by the specific client contract.
  • Determined status via letter and sent to all appropriate parties.

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33. Medical Research

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low Demand

34. Social Security

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low Demand

35. Information ACT

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low Demand
Here's how Information ACT is used in Appeals Officer jobs:
  • Handled Freedom of Information Act (FOIA) issues ensuring there are no breeches involving sensitive patient information.

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Appeals Officer Jobs

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20 Most Common Skills For An Appeals Officer

Medicare

21.9%

Administrative Hearings

8.0%

Ensure Compliance

8.0%

State Regulations

6.5%

Veterans

5.5%

CMS

5.5%

Audit Procedures

5.0%

IRS

4.5%

Law Enforcement

4.5%

Legal Documents

4.0%

Appeals Process

3.5%

Administrative Appeals

3.0%

Independent Physician Consultants

3.0%

Appeal Officer

2.5%

Tax Court

2.5%

Counsel

2.5%

Medicaid

2.5%

Hipaa

2.5%

Medical Necessity

2.5%

Court Hearings

2.5%
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Typical Skill-Sets Required For An Appeals Officer

Rank Skill
1 Medicare 17.5%
2 Administrative Hearings 6.4%
3 Ensure Compliance 6.4%
4 State Regulations 5.2%
5 Veterans 4.4%
6 CMS 4.4%
7 Audit Procedures 4.0%
8 IRS 3.6%
9 Law Enforcement 3.6%
10 Legal Documents 3.2%
11 Appeals Process 2.8%
12 Administrative Appeals 2.4%
13 Independent Physician Consultants 2.4%
14 Appeal Officer 2.0%
15 Tax Court 2.0%
16 Counsel 2.0%
17 Medicaid 2.0%
18 Hipaa 2.0%
19 Medical Necessity 2.0%
20 Court Hearings 2.0%
21 Federal Contract Compliance 1.6%
22 Federal Courts 1.6%
23 Nso 1.6%
24 Relevant Contract Law 1.6%
25 Research Issues 1.6%
26 Client Contracts 1.2%
27 BVA 1.2%
28 Additional Information 1.2%
29 Applicable Regulations 1.2%
30 Military Personnel 1.2%
31 Staff Members 1.2%
32 Appropriate Parties 1.2%
33 Medical Research 1.2%
34 Social Security 1.2%
35 Information ACT 1.2%
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