Case Analyst

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:

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.

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.  
• Conducts research using online federal regulations, policy, and other related resources to complete an accurate and well-supported decision.

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 OR Licensed attorney with at least one (1) year of experience in healthcare regulatory interpretation/application

• United States resident for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)
• Medicare, preferred
• 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 Vet/Disability