Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.

*This position is located Remote, Anywhere*

*Due to being a federal contractor, you may be subject to obtaining and maintaining a public trust security clearance from the federal government. *

Position Purpose

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.

Essential 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.

Minimum Qualifications

Education

• High School Diploma or equivalent

Experience

• 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.)
• Two (2) years high volume of customer calls, appeals, or billing
• Medicare Part A, preferred
• Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

Benefits

C2C offers an excellent benefits package, including:

• 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

EOE Vet/Disability

High school diploma or equivalent; 3 years general office experience; 2 years high-volume customer calls, appeals, or billing; Medicare Part A preferred; resided in US 3 of last 5 years; public trust clearance required.

Key Responsibilities

• writing appeal decisions
• researching regulations
• organizing documents

Job Details

• Category: Healthcare Services - Allied Health
• Seniority: Mid Level
• Commitment: Full Time
• Workplace: Remote — United States
• Languages: English

Benefits

• Tuition reimbursement
• Retirement plan

About TMF Health Quality Institute

A health quality institute making second-level non-medical appeal decisions for beneficiaries, suppliers, and providers. — Industry: Healthcare