About this opportunity
TMF Health Quality Institute lists this Dispute Resolution Analyst opportunity in san diego, California. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Job TitleServes as a support person for the reconsideration/dispute resolution professionals and physician reviewers for second level reconsiderations/dispute resolutions.Job DescriptionCoordinates 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.Minimum QualificationsEducation:High School Diploma or equivalentExperience: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.)Healthcare experience, preferredBenefitsC2C offers an excellent benefits package, including:Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insuranceSection 125 plan401KCompetitive salaryLicense/credentials reimbursementTuition ReimbursementEOE Vet/DisabilityEqual Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Worksite address
san diego, CA, 92199, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.