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 Services (CMS) or other customer entities. ● 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. ● Stays abreast of changes in regulations and practices, policies and procedures. ● Participates in special projects and performs other duties as assigned.