Remote Medicare LEP Appeals Specialist

TMF Health Quality Institute; United States, Northern America, Americas; Hybride; USD 36 000 - 52 000; Plein temps

Résumé du poste

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.

Qualifications

• 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.

Responsabilités

• 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.

Formation

High School Diploma or equivalent

Description du poste

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.