Reconsideration Analyst

Job Description

JOB DETAILS

REQUIREMENTS

• High School Diploma or equivalent
• 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.)

RESPONSIBILITIES

• Coordinates the delivery of re-determination files/dispute resolution documents and reconsideration/dispute resolution decisions from and to the external entities.
• Builds a reconsideration/dispute resolution case file from evidence submitted and received and analyzes each case to ensure it meets the requirements for a valid reconsideration/dispute resolution 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 request, and dispute resolution settlement documentation.
• Inputs appropriate data regarding reconsiderations/dispute resolution cases into the applicable required systems.
• Responds to reconsideration/dispute review requests from appellants/patients/providers.

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