Reconsideration Analyst II - J29, Inc

Overview:
J29, Inc. has been supporting commercial, State, and Federal health and human service programs since company inception in 2017. Our team of 160 employees focuses on providing claim, policy, and clinical analysis on the end-to-end of medical cases, claims, disputes, appeals, and audits. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels.
 
J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that needs us most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow




Position Purpose:

Performs moderately complex (journey-level) appeals work. Conducts second level non-medical Medicare appeals decisions for beneficiaries and suppliers, including cases dismissed by the contractor. Works under moderate supervision, with moderate latitude for the use of initiative and independent judgement.

Essential Responsibilities:

· Writes a reconsideration decision that is clear and supports the determination made.

· Ensures that all appeal issues raised by the beneficiary, representative, and supplier have been addressed.

· Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.

· Ensures all documents are releasable and do not violate any Privacy Act provisions.

· Organizes documents by dates of service relevant to the charges, research denials and regulations used by the contract and ensure that any overpayment calculation made is correct.

· Conducts research using online federal regulations, Medicare policy, standards of medical practice, contractor manuals, coverage issues manuals, and other related resources to complete accurate and well-supported decision.

· Makes sound, independent decisions based on the submitted evidence in accordance with statutes, regulation, rulings, and Centers for Medicare & Medicaid Service (CMS) policy.

· Stays abreast of changes in regulations and practices, policies and procedures.

· Participates in special projects and performs other duties as assigned.

Minimum Qualifications

Education

· High School Diploma or equivalent

Experience

· Two (2) years of general office experience

o 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 of Medicare appeals or Managed Care appeals

· Experience directly relevant to the specific task order or project, preferred

Knowledge, Skills and Abilities

Working Knowledge of

· Research techniques

· Medicare appeals program

· Applicable systems and applications

· Applicable laws, rules and regulations

Proficient Skill in

· Prioritizing and organizing work assignments

· The use of personal computers and applicable programs, applications and systems

Some Skill in

· Preparing correspondence/documents using correct spelling, grammar and punctuation; proofreading and reviewing documents for clarity and consistency

· Researching, analyzing and interpreting policies and state and federal laws and regulations

Ability to

· Meet production and quality standards

· Multitask and meet deadlines

· Exercise logic and reasoning to define problems, establish facts and draw valid conclusions

· Make decisions that support business objectives and goals

· Identify and resolve problems or refer issues appropriately

· Communicate effectively verbally and in writing

· Adapt to the needs of internal and external customers

· Show integrity and ethical behavior; respect confidentiality, business ethics and organizational standards

· Assures compliance with company policies, procedures, and guidelines including cybersecurity, regulatory, contractual and accreditation entities

J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class.  J29, Inc. is a proud Veteran friendly employer.
 

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