Reconsideration Analyst
Current- Coordinates the delivery of redetermination case files and reconsideration decisions from and to stakeholders, e.g., appellants and Part D plans.
- Builds a reconsideration case file from evidence submitted and received, and analyzes each case to ensure it meets the requirements for a valid reconsideration request as mandated by Centers for Medicare and Medicaid.
- Analyzes and makes an analysis on the validity of each appeal.
- Accurately inputs appropriate data regarding enrollee appeal requests and Part D plan case files into the applicable required systems.
- Requests Appointment of Representation documents for reconsideration requests from appellants
- Identifies any suspected instances of fraud and/or abuse and immediately inform management of such issues.
Dec 2021 - Present
