Results

Responsible for providing leadership and direction of all Provider/Supplier Enrollment appeal (CAPs/reconsiderations) and rebuttal operations for the NPEast contract, utilizing analytical skills and regulatory knowledge to ensure timely and compliant adherence with all Provider Enrollment appeal and rebuttal contractual obligations, CMS program guidance and departmental procedures. This includes leading, managing, and providing direction for all appeals activities and rebuttal processes.

This position does not interpret statutes or regulations for the purpose of providing legal advice and does not act as an attorney for the organization.

The Appeals Manager provides direct leadership and management for lower-level exempt and higher-level non-exempt individual contributors.

 

ESSENTIAL RESPONSIBILITIES

Manager, Appeals & Rebuttals

A healthcare services organization is seeking a Manager, Appeals & Rebuttals to lead provider and supplier enrollment appeal and rebuttal operations in a regulated Medicare environment. This individual will oversee a small team, manage performance for timeliness and quality, and ensure work is executed in accordance with contractual requirements, CMS guidance, and internal procedures.

This is a remote, permanent opportunity with occasional travel as needed for client-related meetings.

Compensation

$100,000 to $130,000 base salary
10% target bonus

Work Model

Remote
Preference for candidates located near Northeast Florida or the Mechanicsburg, PA area is helpful, but not required.
Travel may be required based on client needs, though frequency is not yet defined.

Position Overview

The Manager, Appeals & Rebuttals will provide leadership for day-to-day appeals and rebuttal operations related to provider and supplier enrollment determinations. The role requires strong regulatory judgment, disciplined execution, and the ability to manage complex case workflows in a structured environment.

This position partners closely with internal leadership, compliance, and legal stakeholders to support timely, accurate, and well-documented case outcomes. It is a management role with approximately 4 to 6 direct reports.

Key Responsibilities

Leadership, Operations, and Compliance

• Lead daily operations for appeals and rebuttals related to provider and supplier enrollment determinations
• Manage workflow, quality review, staff oversight, and employee development for a small team
• Maintain performance metrics tied to timeliness and quality
• Ensure appeals and rebuttal decisions align with federal regulations, contractual obligations, and program guidance
• Review complex cases, assess facts, and support consistent, policy-aligned outcomes
• Operationalize updates from contractual and regulatory guidance, including changes that affect enrollment functions
• Identify trends, risks, and opportunities for process improvement, and escalate issues when appropriate
• Coordinate with internal and external legal stakeholders on documentation, case strategy, and administrative record development
• Support interactions with federal client stakeholders as needed regarding appealable and rebuttable determinations

Appeals and Rebuttal Strategy

• Lead strategy for appeal and rebuttal responses
• Ensure narratives are supported by evidence, policy, and regulatory requirements
• Establish and maintain processes that promote timely, accurate, and compliant case handling
• Identify recurring issues and incorporate findings into training, workflow improvements, and policy updates

Cross-Functional Collaboration

• Serve as a subject matter resource and escalation point for internal leaders and partners
• Collaborate across teams to improve upstream processes and reduce avoidable appeal volume
• Analyze data to identify operational gaps, compliance risks, and performance trends
• Present findings, risks, and recommendations to senior leadership

Required Qualifications

• J.D. and/or LL.M. from an ABA-accredited law school
• 3+ years of experience in administrative law or post-J.D./post-LL.M. legal writing and research
• 5+ years of supervisory or team leadership experience in legal writing, legal research, and/or administrative law
• Strong verbal and written communication skills
• Demonstrated ability to make objective decisions in a structured, high-compliance environment
• Experience analyzing workflows and performance data to improve operations and support regulatory compliance
• Ability to collaborate effectively with multiple stakeholders across leadership and partner teams
• Ability to pass an additional government background investigation required for access to government systems

Preferred Qualifications

• Supervisory or management experience in a Medicare production environment
• Experience supporting provider or supplier enrollment appeals, rebuttals, or related regulatory operations
• Familiarity with regulated healthcare operations involving federal program guidance and contractual service requirements

Ideal Background

• Prior experience leading structured appeals or rebuttal workflows in a highly regulated setting
• Strong comfort level with detailed review work, documentation standards, and process discipline
• Experience working with senior stakeholders in environments where consistency, compliance, and turnaround expectations are critical

Apply

Candidates with a legal background and management experience in regulated healthcare or administrative law environments are encouraged to apply. This role is well suited for someone who values structure, precision, and operational accountability in a remote leadership setting.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

Leadership, Operations, and Compliance (70%)

Accountable for the oversight and effective management of all appeals and rebuttals for the NPEAST contract. The department is responsible for responding to all requests expressing dissatisfaction with the initial provider/supplier enrollment determinations:

* Lead, direct and manage the daily operations of the Durable Medical Equipment, Prosthetics, Orthotics and Suppliers (DMDPOS) appeals and rebuttals, including workflow management, quality review and staff development.

* Ensure appeal decisions are consistent with federal regulatory requirements, contractual obligations and CMS program guidance.

* Accountable for reviewing and operationalizing requirements outlined in Technical Direction Letters (TDLs), Change Requests (CRs), the Statement of Work (SOW), and the Medicare Program Integrity Manual (PIM) and ensuring their timely and accurate implementation across all enrollment functions.

* Review complex appeal cases to assess facts, apply existing policies and guide consistent outcomes.

* Identify trends, risks and process improvement opportunities and escalate matters appropriately.

* Serve as a key liaison and partner to internal and external legal counsel, contributing to case strategy, documentation standards, administrative record development, and supports decision-making by identifying risks and operational impacts.

* Interact with the Centers for Medicare & Medicaid Services (CMS) and the Office of the General Counsel (OGC), as requested by CMS, to timely and accurately adjudicate provider/supplier enrollment initial determinations, deactivations, and stays of enrollment that may be appealed or rebutted.

* Review and process appealable determinations (such as denial of billing privileges, revocation of existing billing privileges, and effective date determinations and rebuttable determinations (such as deactivation of billing privileges and the application of stays of enrollment) in accordance with applicable CMS program guidance.

* Coordinate with CMS and internal stakeholders to ensure appeals are supported with complete documentation, clear rationale, and consistent application of regulatory requirements.

Appeal and Rebuttal Strategy and Risk Mitigation (15%)

* Lead the appeals (CAP/reconsideration) rebuttal strategy

* Ensure appeals (CAP/reconsideration) and rebuttal narratives are supported by evidence, policy, and regulatory requirements.

* Establish and maintain processes and workflows that ensure appeals and rebuttals are handled timely and accurately.

* Identify trends in rebuttal and appeals that can be incorporated into training, policy updates, and process redesign

Cross-Functional Collaboration and Process Improvement (15%)

* Serve as subject matter expert and primary escalation contact for internal leaders, external partners, and regulatory bodies

* Collaborate with Legal to ensure clear and accurate interpretation of regulatory authority and CMS guidance, where appropriate.

* Support cross-functional initiatives to reduce appeal and rebuttal volume through upstream improvements.

* Analyze data to identify patterns, compliance risks, and operational gaps.

* Present trends, risks, and recommendations to senior leadership while providing insights into root causes and risk exposure

Performs other duties as the supervisor may, from time to time, deem necessary.

 

 

REQUIRED QUALIFICATIONS

* J.D. and/or LL.M degree from a law school accredited by the American Bar Association

* Three (3) or more years of prior work experience in administrative law or post-Juris Doctor (J.D), and/or post-Master of Laws (LL.M) experience in legal writing and research; and five (5) or more years of prior supervisory/team lead experience in legal writing, legal research, and/or administrative law.

* Demonstrated ability to handle risk and uncertainty, cope with change, and make objective decisions based on limited information.

* Demonstrated ability to analyze workflow and benchmark data to identify process improvements and ensure compliance with Medicare regulations and performance requirements.

* Demonstrated oral, written and interpersonal communications skills.

 

 

PREFERRED QUALIFICATIONS

* Supervisory or managerial experience in a Medicare production environment

Ascendo is a certified minority owned staffing firm, and we welcome and celebrate diversity. Ascendo is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, parental status, military service or any other characteristic protected by federal, state or local law.

Contact information

Christian Kincer

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