TMF Health Quality Institute ยท 2 days ago
Reconsideration Analyst III
Wonder how qualified you are to the job?
Health CareHospital
Insider Connection @TMF Health Quality Institute
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
Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.
Required
High School Diploma or equivalent
Three (3) years of general office experience
Two (2) years high volume of customer calls, appeals, or billing Medicare
Preferred
College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis
Customer Service experience
Benefits experience
Benefits
Medical
Dental
Vision
Life insurance
Accidental death and dismemberment insurance
Short and long-term disability insurance
Section 125 plan
401K
Competitive salary
License/credentials reimbursement
Tuition Reimbursement