Note: The job is a remote job and is open to candidates in USA. TMF Health Quality Institute is hiring a Reconsideration Analyst I to support reconsideration and dispute resolution professionals and physician reviewers. The role involves coordinating case documents, reviewing and validating reconsideration requests, analyzing case types and appeal categories, entering case data into required systems, and responding to requests from appellants, patients, and providers.
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
Skills
- High School Diploma or equivalent
- 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 Part A, preferred
Benefits
- Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
- Section 125 plan
- 401K
- License/credentials reimbursement
- Tuition Reimbursement
- This position is located Remote United States
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