Reconsideration Analyst II

* This position is located Remote United States*

* This position requires r otating weekends and holidays*

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

• 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 over payment 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.

• High School Diploma or equivalent

• 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
• Medicare Part C related appeals activities, preferred

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Tuition Reimbursement

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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