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 Anywhere US*

Position Purpose:

Performs advanced (senior-level) quality assurance and supervisory work.  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:

• Oversees, plans, and monitors the quality assurance program.
• Oversees, plans, and audits to ensure timeliness, accuracy, and consistency in reconsideration/dispute resolution decisions.
• Oversees, develops, and identifies individual and collective training opportunities based on audit findings and/or data analysis of reconsiderations/dispute resolution decisions to help improve individual and corporate quality.
• Oversees, plans, prepares, reviews and analyses data to identify problems, trends and improvement opportunities.
• Oversees, plans, and reviews reopened cases and cases from the problem log in order to identify trends and needs for improvement.

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

PLEASE VISIT OUR CAREER CENTER TO APPLY AND VIEW FULL JOB DESCRIPTION!

https://jobs.tmf.org/

EOE Minorities/Females/Vet/Disability

Requirements

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

• Five (5) years medical dispute, Medicare appeals or clinical experience in a healthcare setting

• Three (3) years management or supervisory
• Three (3) years quality assurance oversight for work directly related to the Medicare program (e.g., quality assurance oversight at the QIC, MAC, or other equivalent experience) (Required per contract)

• Two (2) years of training
• Medicare Part B
• Healthcare Professional with demonstrated experience writing or making medical necessity decisions
• Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience