C2C INNOVATIVE SOLUTIONS

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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:

Provides subject matter expertise to staff and decision makers through technical support and one-on-one training.

Essential Responsibilities:

Serves as a lead staff member and subject matter expert for Appeals Specialists, Clerks, Dispute Resolution Analyst, Intake Specialists, LEP Analysts, and/or Reconsideration Analyst.

Uses subject-matter knowledge and judgment related to contract processes to carry out automated tasks or reopening case file requests.

Assists with questions related to the contract or project. This may include, but is not limited to, corrections and detailed explanations as to how to properly comply with Centers for Medicare and Medicaid Services (CMS) guidelines.

Assists in ensuring the staff or department is meeting goals in support of the contract and company policies.

Assists in facilitating meetings, including staff meetings to discuss quality measures and provide training.

Acts as a liaison between the company, Affiliated Contractors, and / or internal staff dealing with specialized case matters (e.g., late files, missing data, unique cases, corrections) to verify they are

Minimum Qualifications

Education

High School diploma or equivalent **

Experience

Three (3) years 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.)

One (1) year Mailroom, Medicare appeals, Managed Care appeals, Healthcare or Health Insurance industry

Medicare Part A, preferred

Quality Letter System (QLS), preferred

Medicare Appeal System (MAS), preferred

C2c Solutions, Inc.

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