Regulatory Specialist

1 week ago

Washington, United States West 4th Strategy Full time
Job Overview

We are seeking a skilled Regulatory Specialist to join our team at the Department of Health and Human Services, Office of the Secretary, Departmental Appeals Board. As a key member of our team, you will be responsible for managing the appeal process, ensuring timely case processing, and providing exceptional support to our stakeholders.

About the Role

This is a dynamic opportunity for an experienced professional to utilize their analytical skills, attention to detail, and excellent communication abilities to excel in a fast-paced environment. You will work closely with our team to ensure that all appeals are processed efficiently and effectively, maintaining the highest level of customer satisfaction.

Responsibilities
  • Conduct thorough screening of Medicare appeals within seven working days of assignment, identifying any issues or discrepancies that may impact the appeal process.
  • Prepare administrative records for U.S. Federal Court, ensuring accuracy and completeness.
  • Screen claim files for completeness, proper jurisdiction, and other designated elements, making recommendations for further action as needed.
  • Docket new appeals in the electronic case filing system, ensuring timely and accurate entry.
  • Convert final action documents into PDF format utilizing Adobe Pro, maintaining high-quality formatting and clarity.
  • Request missing Administrative Law Judge (ALJ) hearing files and decisions within seven working days, ensuring seamless appeal processing.
  • Upload items upon receipt to file cabinet on the same day, promoting efficiency and organization.
  • Prepare interim letters to cure case processing errors within seven days of assignment, communicating clearly and professionally.
  • Upload interim letters into e-filing system with correct event recorded, ensuring accurate tracking and follow-up.
  • Request consent to email Council decisions while the Departmental Appeals Board is in telework status, facilitating efficient communication.
  • Save copies of Council decisions issued the previous week to shared J drive, maintaining historical records.
  • Prepare and ship boxes to contractors and/or paper files to be digitized to Quality Associate Incorporated, ensuring secure and efficient transfer.
  • Scan and upload paper components of files to File Cabinet in order to process cases in telework status, promoting flexibility and productivity.
  • Process incoming appeal requests and correspondence, responding promptly and professionally.
  • Open and span all incoming mail and log it in Mail log within two business days, maintaining organizational control.
  • Refer unusual correspondence and questions to COR, ensuring expert guidance and support.
  • Complete docketing of requests for review, claims files, and paper requests for review, accurately tracking and updating appeal status.
  • Prepare Acknowledgment Letter within two business days of request, confirming receipt and next steps.
  • Update DABACTS to reflect receipt of claim files within two business days of receipt, maintaining accurate records.
  • Upon receipt of case file, update missing Case Menu information and case location in DAB ACTS, ensuring seamless appeal processing.
  • Prepare and mail final decisions, orders, and letters within prescribed period, meeting regulatory requirements.
Requirements
  • Bachelor's degree or equivalent experience in a related field, such as law, policy, or administration.
  • At least one year of experience conducting legal research, analyzing complex documents, and preparing written briefs and memoranda.
  • Excellent analytical, problem-solving, and communication skills, with ability to work independently and collaboratively in a fast-paced environment.
  • Strong knowledge of Medicare regulations, policies, and procedures, with ability to apply this knowledge in a practical setting.
  • Proficiency in Microsoft Office Suite, particularly Word and Excel, with ability to learn and adapt to new software systems.
  • U.S. Citizenship and ability to pass background investigation to handle sensitive information, as required by HSPD-12 credentialing requirements.
What We Offer
  • Competitive salary: $85,000 per annum.
  • Fulfilling career opportunities in a dynamic organization.
  • A comprehensive benefits package, including medical, dental, and vision coverage, retirement plan, and paid time off.
  • Opportunities for professional growth and development, including training and education assistance.
  • A collaborative and inclusive work environment, with a diverse team of professionals dedicated to public service.

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