Late Enrollment Penalty Analyst

TMF Health Quality Institute; United States; Hybrid; USD 36.000 - 52.000; Vollzeit

Zusammenfassung

TMF Health Quality Institute is seeking a remote team member to conduct Medicare prescription drug non-medical reconsideration and LEP decisions. You will write clear, well-supported decisions and ensure all issues are researched according to CMS regulations and Health Plan formulary policies.

Qualifications include a high school diploma and at least two years of general office experience. LEP-appeals experience is preferred; residency in the United States for the past three years is required.

Qualifikationen

• High School Diploma or equivalent.
• Two years of general office experience.
• Experience with Part D LEP appeals preferred.
• Residency in the United States for the past 3 of the last 5 years.

Aufgaben

• Writes a non-medical prescription drug reconsideration or LEP decision that is clear and supports the determination.
• Ensures that all appeal issues raised have been researched and addressed.
• Provides a fair and impartial decision based on CMS regulations, policies, and formulary rules.
• Ensures all documents are releasable and do not violate Privacy Act provisions.
• Conducts research using CMS regulations, Health Plan formulary policies, and CMS systems (HPMS/MAS) to complete accurate decisions.
• Makes sound, independent decisions based on the submitted evidence and CMS regulations.

Ausbildung

High School Diploma or equivalent

Jobbeschreibung

Position Purpose:

Conducts Medicare prescription drug non-medical reconsideration decisions or Late Enrollment Penalty (LEP) decisions.

• Writes a non-medical prescription drug reconsideration or LEP decision that is clear and supports the determination made.
• Ensures that all appeal issues raised have been researched and addressed.
• Provides a fair and impartial decision based on the presentation of facts, Centers for Medicare & Medicaid Service (CMS) regulations and policies, and Health Plan formulary rules or other relevant information.
• Ensures all documents are releasable and do not violate any Privacy Act provisions.
• Conducts research using online federal regulations and Medicare policy provisions, Health Plan formulary policies or subscriber materials, and CMS systems including the Health Plan Management System (HPMS) and the Medicare Appeals System (MAS), to complete accurate and well-supported decisions.
• Makes sound, independent decisions based on the submitted evidence in accordance with CMS regulations and policies, and Health Plan formularies and/or subscriber materials.

This position is located Remote United States

Minimum Qualifications

Education

• High School Diploma or equivalent

Experience

• 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.)
• Experience directly relevant to Part D Late Enrollment Penalty appeals, preferred
• Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

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.