Job Details

**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 shouldalso address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**

*This position is located Remote United States*

Position Purpose:

Conducts second level non-medical Medicare appeals decisions , including review of appeal cases dismissed by the level 1 contractor.

Essential Responsibilities:

• Writes a non-medical reconsideration decision that is clear and supports the determination made.
• Ensures that all appeal issues raised by the party (e.g., enrollee, representative, ornon-contract 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 by the contract and ensure that any overpayment calculation made is correct.
• Conducts research using online federal regulations, Medicare policy, standards of medical practice, contractor manuals, coverage issues manuals, and other related resources to complete accurate and well-supported decision.

Minimum Qualifications

Education

• High School Diploma or equivalent

Experience

• Two (2) 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.)

• One (1) year of Medicare appeals or Managed Care appeals

• Experience directly relevant to Medicare managed care appeals or utilization management activities, 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

EOE Vet/Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.