Healthcare Regulatory Specialist

2 weeks ago


Columbia, Maryland, United States C-HIT Full time
Job Overview

C-HIT is seeking a highly skilled and detail-oriented professional to join our team as a Case Analyst. In this role, you will play a critical part in receiving, processing, and rendering written decisions in support of the Centers for Medicare & Medicaid Services (CMS) Appeals and Rebuttals provider enrollment administrative actions program.

Key Responsibilities:

  • Act as an internal consultant by providing guidance and support to assist Appeals specialists, Project Managers, and QA Managers in the development of written decisions on the Appeal or Rebuttal.
  • Provide high-quality customer service to all providers/suppliers/properly appointed representatives as it relates to the submission, processing, and issuance of decisions for rebuttals, CAPs, and reconsideration requests.
  • Understand and properly use and interpret various federal policies, regulations, and systems in response to providers that are challenging provider enrollment administrative actions rendered by CMS.
  • Follow all detailed instructions when receiving, processing, and rendering written decisions.
  • Participate actively in business decision-making by offering qualitative feedback, recommendations, and discussing what-if scenarios.
  • Influence and analyze time-sensitive case responses.
  • Coach, support, and cross-train with peers. Input case details in the requisite systems.
  • Opportunities for travel may arise occasionally for in-person meetings, trainings, and presentations.

Requirements:

  • Possess either: (1) a 4-year degree from an accredited institution (i.e., a Bachelor's degree) with at least one year of experience in healthcare regulatory interpretation/application and/or in healthcare compliance, or without Bachelor's Degree with at least 2-5 years of experience in healthcare regulatory interpretation/application and/or in healthcare compliance.

C-HIT is an EOE, including disability and veterans.



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