Reconsideration Analyst III (Part C)

Tmf/C2C • Austin, TX

18h • Remote

About The Position

Makes second level non-medical appeal decisions. This may include review of appeal cases dismissed by the level 1 contractor 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 (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
• Two (2) years high volume of customer calls, appeals, or billing Medicare Part C related appeals activities

Responsibilities

• Writes a non-medical reconsideration decision that is clear and supports the determination
• 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
• Organizes documents by dates of service relevant to the charges, research denials and regulations used and ensure that any overpayment calculation is correct.

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