Reconsideration Analyst I (Part C)
About The Position
This position serves as a support person for reconsideration professionals and physician reviewers for second-level reconsiderations resolutions. The role involves coordinating the delivery of appeals case files, resolution documents, and reconsideration decisions. It also requires building reconsideration case files from submitted evidence, analyzing cases to ensure they meet CMS or other customer entity requirements, and making decisions based on medical vs. non-medical case types, appeal/review categories, and appeal validity. The analyst will input data into required systems and respond to appellants/providers regarding reconsiderations.
Requirements
- High School Diploma or equivalent
- One (1) year of general office experience
- Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)
Nice To Haves
- College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis.
- Medicare Part C related appeals activities
Responsibilities
- Coordinates the delivery of appeals case files resolution documents and reconsideration decisions from and to the external entities.
- Builds a reconsideration case file from evidence submitted or auto-forwarded from Plans and analyzes each case to ensure it meets the requirements for a valid reconsideration as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities.
- Analyzes and makes decisions based on medical vs. non-medical case type, appeal/review categories, validity of appeal.
- Inputs appropriate data regarding reconsiderations into the applicable required systems.
- Responds to reconsideration from appellants//providers.
Benefits
- Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
- Section 125 plan
- 401K
- Competitive salary
- License/credentials reimbursement
- Tuition Reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
