Remote, Anywhere USA
Austin, TX 78727, USA

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 moderately complex (journey-level) appeals work. Conducts Medicare prescription drug non-medical reconsideration decisions or Late Enrollment Penalty (LEP) decisions. Works under moderate supervision, with moderate latitude for the use of initiative and independent judgement.

Writes a non-medical prescription drug reconsideration or LEP decision that is clear and supports the determination made.
Ensures that all appeal issues raised have been researched and addressed.
Provides a fair and impartial decision based on the presentation of facts, Centers for Medicare & Medicaid Service (CMS) regulations and policies, and Health Plan formulary rules or other relevant information.
Ensures all documents are releasable and do not violate any Privacy Act provisions.
Conducts research using online federal regulations and Medicare policy provisions, Health Plan formulary policies or subscriber materials, and CMS systems including the Health Plan Management System (HPMS) and the Medicare Appeals System (MAS), to complete accurate and well-supported decisions.
Makes sound, independent decisions based on the submitted evidence in accordance with CMS regulations and policies, and Health Plan formularies and/or subscriber materials.

Minimum Qualifications

Education

High School Diploma or equivalent

Experience

Two (2) years 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.)
Experience directly relevant to Part D Late Enrollment Penalty appeals, preferred

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
Tuition Reimbursement

EOE Minorities/Females/Vet/Disability

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TMF Health Quality Institute

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