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Case Analyst

  • TMF Health Quality Institute
  • Remote Anywhere US
  • Jan 10, 2025
Full time Health Care

Job Description

C2C INNOVATIVE SOLUTIONS

https://www.c2cinc.com/

 

Please visit our Career Center to Apply and View the Full Job Description!

https://jobs.tmf.org/

 

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 providers and/or suppliers the opportunity to present documentation or evidence to demonstrate why an appeal or rebuttal for an enrollment denial, revocation, or suspension should or should not be allowed. Provides an independent decision 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 case file, writes a decision that is clear, concise, and impartial and supports the decision made.
  • Makes sound, independent decisions based on evidence in accordance with statutes, regulation, rulings, and policy.
  • Acts as internal consultant by providing guidance and support to assist Appeals specialist, Project Manager, and QA Manager in the development of written decisions.  
  • Provides high quality customer service to all providers/suppliers/properly appointed representatives as it relates to the submission, processing, and issuance of decisions.  

 

 

Minimum Qualifications

 

Education and Experience (Per Contract Requirements)

  • Bachelor’s degree from an accredited college or university and Three (3) years experience in healthcare regulatory interpretation/application and/or healthcare compliance OR Paralegal Certificate from an accredited institution and Three (3) years experience working as a paralegal
  • Legal writing experience, 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 Minorities/Females/Vet/Disability

 

About TMF Health Quality Institute

TMF Health Quality Institute focuses on promoting quality health care through contracts with federal, state and local governments, as well as private organizations. For more than 50 years, TMF has helped health care providers and practitioners in a variety of settings improve care for their patients.

TMF was chartered in 1971 as a private, nonprofit organization of licensed physicians (MDs and DOs) to lead quality improvement and medical review efforts in Texas. Originally known as the Texas Medical Foundation, the company changed its name to TMF Health Quality Institute in 2005 to reflect the expansion of its work throughout the nation.

TMF’s programs and services—ranging from quality improvement consulting and technical assistance to research, data analysis and medical review—engage all aspects of health care. Our programs have worked directly with thousands of physicians and other health care providers across the United States, affecting millions of people from children to senior citizens.

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