Note: The job is a remote job and is open to candidates in USA. TMF Health Quality Institute is seeking a Reconsideration Analyst II to support Medicare appeals operations. The role conducts second-level non-medical Medicare appeals reviews, researches applicable regulations and policies, and prepares clear, fair, and well-supported reconsideration decisions.
Responsibilities
- Writes a non-medical reconsideration decision that is clear and supports the determination made
- Ensures that all appeal issues raised by the party (e.g., enrollee, representative, ornon-contract provider) have been addressed
- Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures
- Ensures all documents are releasable and do not violate any Privacy Act provisions
- Organizes documents by dates of service relevant to the charges, research denials and regulations used by the contract and ensure that any overpayment calculation made is correct
- Conducts research using online federal regulations, Medicare policy, standards of medical practice, contractor manuals, coverage issues manuals, and other related resources to complete accurate and well-supported decision
Skills
- High School Diploma or equivalent
- Two (2) years 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.)
- One (1) year of Medicare appeals or Managed Care appeals
- Medicare Part C related appeals activities, preferred
Benefits
- Remote work in the United States
- Medical, dental, vision, life, accidental death and dismemberment, and short- and long-term disability insurance
- Section 125 plan
- 401K
- License/credentials reimbursement
- Tuition reimbursement
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