Dispute Resolution Analyst I

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 US*

Position Purpose:

Performs routine appeals work. Serves as a support person for the reconsideration/dispute resolution professionals, physician reviewers and CMS for second level reconsiderations/dispute resolutions and provider enrollment appeals and rebuttals. Works under close supervision, with minimal latitude for the use of initiative and independent judgement.

Essential Responsibilities:

• Coordinates the delivery of re-determination files/dispute resolution documents, reconsideration/dispute resolution decisions, case file, and related documents from and to the external entities.
• Builds a case file from documentation submitted and received and analyzes each case to ensure it meets the requirements for a valid reconsideration/dispute resolution, appeal or rebuttal request as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities.
• Analyzes and makes decisions based on medical vs. non-medical case type, appeal/review categories, validity of appeal/dispute resolution, appeal or rebuttal request, and related documentation.
• Inputs appropriate data regarding cases into the applicable required case management systems.
Identifies any suspected instances of fraud and/or abuse and immediately inform management of such issues.

Minimum Qualifications

Education

Experience

• One (1) year 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.)
Independent Dispute Resolution, preferred

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

PLEASE VISIT OUR CAREER CENTER TO APPLY AND VIEW FULL JOB DESCRIPTION!

https://jobs.tmf.org/

EOE Minorities/Females/Vet/Disability