Dispute Resolution Analyst

TMF Health Quality Institute; Austin (TX); Remote; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking a detail-oriented support person for their reconsideration and dispute resolution team. This remote role involves coordinating files, analyzing cases, and ensuring compliance with CMS requirements. Ideal candidates will possess strong analytical and communication skills, with a background in office administration. The company offers a comprehensive benefits package, including medical, dental, and 401K plans, making this an attractive opportunity for those looking to contribute to a meaningful cause in healthcare.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

401K

Tuition Reimbursement

Qualifications

• 1 year of general office experience required.
• Education in administration or business can substitute for experience.

Responsibilities

• Coordinate delivery of dispute resolution documents.
• Analyze and build case files for reconsideration requests.
• Input data into required systems regarding cases.

Skills

Analytical Skills

Communication Skills

Office Administration

Education

High School Diploma or equivalent

Job description

Please ensure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills, and abilities needed for the role. Incomplete applications will not be considered.

*This position is located Remote, Anywhere US*

Position Purpose:

Serves as a support person for the reconsideration/dispute resolution professionals and physician reviewers for second level reconsiderations/dispute resolutions.

1. Coordinates the delivery of re-determination files/dispute resolution documents and reconsideration/dispute resolution decisions from and to external entities.
2. 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.
3. 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.
4. Inputs appropriate data regarding reconsiderations/dispute resolution cases into the applicable required systems.
5. Responds to reconsideration/dispute review requests from appellants/patients/providers.

Minimum Qualifications

Education

• High School Diploma or equivalent

Experience

• 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.)

C2C offers an excellent benefits package, including:

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Tuition Reimbursement

EOE Vet/Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.