Job Details
Description
**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 United States_
Position Purpose:
Ensures decision makers adjudicate cases accurately by performing quality audits, reviews, and publishing audit results and conducting meetings, providing coaching, and training on quality. Works under limited supervision, with considerable latitude for the use of initiative and independent judgement.
Essential Responsibilities:
- Performs audits to ensure timeliness, accuracy, and consistency in reconsideration/dispute resolution decisions.
- Participates in planning, preparing, and facilitating discussion for regularly scheduled process and program improvement meetings.
- Oversees, provides and plans training for new and current staff, including developing and presenting presentations, quality tips, and decision consistency memos.
- Participates in special projects and performs other duties as assigned.
- Performs audits and examinations of case files to identify inaccuracies and non-compliance issues.
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 Medicare appeals or clinical 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
- Three (3) years medical dispute, Medicare appeals or clinical experience in a healthcare setting
- Two (2) years of training
- Managed Care
- Healthcare Professional with demonstrated experience writing or making medical necessity decisions
- Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
- Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)
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