Reconsideration Analyst II

TMF Health Quality Institute; Northern (KY); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, vision, life, AD&D, &

short & long-term disability insurance

Section 125 plan

401K

Tuition Reimbursement

Job summary

TMF Health Quality Institute is seeking a second-level non-medical Medicare appeals reviewer for a remote role in the United States. You will draft clear reconsideration decisions and ensure all appeal issues raised are addressed while basing determinations on current evidence, regulations, and policies.

The position involves organizing documents, researching federal regulations and Medicare policies, and ensuring privacy compliance.

Qualifications

• 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.
• One (1) year of Medicare appeals or Managed Care appeals.

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, or non-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.

Education

High School Diploma or equivalent

Job description

*This position is located Remote United States*

* This position requires r otating weekends and holidays*

Position Purpose:

Conducts second level non-medical Medicare appeals decisions , including review of appeal cases dismissed by the level 1 contractor.

• 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.

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.)
• One (1) year of Medicare appeals or Managed Care appeals
• Medicare Part C related appeals activities, preferred

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.