Note: The job is a remote job and is open to candidates in USA. TMF Health Quality Institute is seeking a Reconsideration Analyst III to make second-level non-medical appeal decisions for beneficiaries, suppliers, and providers. The role involves researching regulations and policies, evaluating appeal documentation, and writing clear, accurate, and impartial reconsideration decisions.
Responsibilities
- Writes a reconsideration decision that is clear and supports the determination made
- Ensures that all appeal issues raised by the beneficiary, representative, supplier, and/or 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 and ensure that any overpayment calculation is correct
- Conducts research using online federal regulations, contract policy, standards of medical practice, contractor manuals, coverage manuals, and other related resources to complete an accurate and well-supported decision
Skills
- High School Diploma or equivalent
- Three (3) 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.)
- Two (2) years high volume of customer calls, appeals, or billing
- Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)
- Medicare Part A
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
- Remote work, anywhere
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