C-HIT · 6 hours ago

Case Analyst

United States

Full-time

Remote

Entry, Mid Level

6+ years exp

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ConsultingHealth Care

Comp. & Benefits

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Responsibilities

Acts as internal consultant by providing guidance and support to assist Appeals specialist, Project Manager, and QA Manager in the development of written decisions on the Appeal or Rebuttal.

Provides high quality customer service to all providers/suppliers/properly appointed representatives as it relates to the submission, processing, and issuance of decisions for rebuttals, CAPs, and reconsideration requests.

Understands and properly uses and interprets various federal policies, regulations, and systems in response to providers that are challenging provider enrollment administrative actions rendered by CMS.

Follows all detailed instructions when receiving, processing, and rendering written decisions.

Participates actively in business decision-making by offering qualitative feedback, recommendations, and discussing what-if scenarios.

Influences and analyzes time sensitive case responses.

Coaches, supports, and cross-trains with peers. Inputs case details in the requisite systems.

Opportunities for travel may arise occasionally for in-person meetings, trainings, and presentations.

Qualification

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Healthcare Regulatory InterpretationHealthcare ComplianceWritten Decision MakingFederal Policies UnderstandingQualitative Feedback

Required

Possess either: (1) a 4-year degree from an accredited institution (i.e., a Bachelor's degree) with at least year of experience in healthcare regulatory interpretation/application and/or in healthcare compliance, or without Bachelor's Degree with at least 6 year of experience in healthcare regulatory interpretation/application and/or in healthcare compliance.