Dispute Resolution Reviewer (Non - Healthcare Professional)
- 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 complex (journey-level) work. Provides dissatisfied beneficiaries and/or providers the opportunity to present documentation or evidence to demonstrate why an appeal or rebuttal for an enrollment denial, revocation, or suspension should be allowed. Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines.Works under general supervision, with moderate latitude for the use of initiative and independent judgment.
- Essential Responsibilities:
- Reviews medical records/case file, writes a decision that is clear, concise, and impartial and supports the determination made, and documents review.
- Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, and policy.
- Responds to and ensures that all issues raised by the beneficiary, representative, supplier, and provider have been addressed.
- Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
Minimum Qualifications
- Education
- Associate's degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline
Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate’s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)
- Experience
- One (1) year of Medicare appeals, medical review, clinical, healthcare regulatory interpretation/application, healthcare compliance or related experience in a healthcare setting
- Appeals and Billing, preferred
- Coding Certificate, 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
Job Type: Full-time
- Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Referral program
- Vision insurance
Work Location: Remote
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