TMF Health Quality Institute · 2 days ago

Reconsideration Analyst III

Austin, TX

Full-time

Onsite

Mid Level

3+ years exp

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Work & Life Balance

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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.

May participate in Pre-decisional Appellant Discussions for the purpose of allowing the appellant to be heard and submit additional documentation.

May provide subject matter expertise for Reconsideration Analysts regarding issues being appealed by dissatisfied beneficiaries or suppliers.

Qualification

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Office experienceBilling MedicareCustomer serviceProblem solvingCollege EducationTechnical TrainingAdministrationBenefits Experience