Reconsideration Analyst II (Part C)

Tmf/C2C • Austin, TX

19h • Remote

About The Position

This position conducts second level non-medical Medicare appeals decisions, including reviewing appeal cases dismissed by the level 1 contractor. The role requires writing clear, impartial decisions based on evidence, regulations, policies, and procedures, ensuring all appeal issues are addressed and documents are releasable. Responsibilities include organizing documents, researching denials and regulations, and verifying overpayment calculations. The analyst will conduct 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 decisions.

Requirements

• High School Diploma or equivalent
• 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.)

Nice To Haves

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

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.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED