Case Analyst

Case Analyst

Job Category: Program Management

Requisition Number: CASEA001163

Full-Time

Locations

Remote, Anywhere USA

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 Anywhere US*

Position Purpose:

Performs complex (journey-level) work.  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.  Works under general supervision, with moderate latitude for the use of initiative and independent judgment.

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.  

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
• 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 Minorities/Females/Vet/Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)