Reconsideration Analyst III (Part A)

Tmf/C2C • Austin, TX

6d • Remote

About The Position

Makes second level non-medical appeal decisions for beneficiaries, supplies, or providers. This may include cases dismissed by a contractor, Medicare Secondary Payer (MSP) recovery appeals, or Expedited appeals.

Requirements

• High School Diploma or equivalent
• Three (3) 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.)
• 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

• Two (2) years high volume of customer calls, appeals, or billing Medicare Part A

Responsibilities

• Writes a reconsideration decision that is clear and supports the determination made.
• Ensures that all appeal issues raised by the beneficiary, representative, supplier, and/or 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 and ensure that any overpayment calculation is correct.
• Conducts research using online federal regulations, contract policy, standards of medical practice, contractor manuals, coverage manuals, and other related resources to complete an accurate and well-supported decision.
• Makes sound, independent decisions based on the submitted evidence in accordance with statutes, regulation, rulings, and Centers for Medicare and Medicaid Services (CMS) policy.

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