Reconsideration Analyst I

2 weeks ago

Austin, Texas, United States TMF Health Quality Institute Full time
**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**

*This position is located Remote United States*

Position Purpose:

Performs routine appeals work. Serves as a support person for the reconsideration/dispute resolution professionals and physician reviewers for second level reconsiderations/dispute resolutions. Works under close supervision, with minimal latitude for the use of initiative and independent judgement.

Essential Responsibilities:
  • Coordinates the delivery of re-determination files/dispute resolution documents and reconsideration/dispute resolution decisions from and to the external entities.
  • Builds a reconsideration/dispute resolution case file from evidence submitted and received and analyzes each case to ensure it meets the requirements for a valid reconsideration/dispute resolution request as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities.
  • Analyzes and makes decisions based on medical vs. non-medical case type, appeal/review categories, validity of appeal/dispute resolution request, and dispute resolution settlement documentation.
  • Inputs appropriate data regarding reconsiderations/dispute resolution cases into the applicable required systems.
  • Responds to reconsideration/dispute review requests from appellants/patients/providers.
  • Routes or responds to telephonic and/or written inquiries from appellants/patients about reconsiderations/dispute resolution or about the reconsiderations/dispute resolutions process from appellants/patient or their legally-designated representatives.
Minimum Qualifications

Education
  • High School Diploma or equivalent
Experience
  • One (1) year of general office experience
    • College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
  • Medicare Appeals, preferred
Benefits

C2C offers an excellent benefits package, including:
  • Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
  • Section 125 plan
  • 401K
  • Competitive salary
  • License/credentials reimbursement
  • Tuition Reimbursement
EOE Minorities/Females/Vet/Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR c)

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