Late Enrollment Penalty Analyst
tmf health quality instituteDenver (CO)
Late Enrollment Penalty Analyst
Posted yesterday
tmf health quality instituteDenver (CO)
Compensation, Benefits, and Job Analysis SpecialistsPharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
SENIORITY
Senior
About the role
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: Conducts Medicare prescription drug non-medical reconsideration decisions or Late Enrollment Penalty (LEP) decisions.
Essential Responsibilities:
Writes a non-medical prescription drug reconsideration or LEP decision that is clear and supports the determination made.
Ensures that all appeal issues raised have been researched and addressed.
Provides a fair and impartial decision based on the presentation of facts, Centers for Medicare & Medicaid Service (CMS) regulations and policies, and Health Plan formulary rules or other relevant information.
Ensures all documents are releasable and do not violate any Privacy Act provisions.
Conducts research using online federal regulations and Medicare policy provisions, Health Plan formulary policies or subscriber materials, and CMS systems including the Health Plan Management System (HPMS) and the Medicare Appeals System (MAS), to complete accurate and well-supported decisions.
Makes sound, independent decisions based on the submitted evidence in accordance with CMS regulations and policies, and Health Plan formularies and/or subscriber materials.
Minimum Qualifications:
EducationHigh School Diploma or equivalent ExperienceTwo (2) years of 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.)Experience directly relevant to Part D Late Enrollment Penalty appeals, preferred Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)
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 401KCompetitive salary
- License/credentials reimbursement
- Tuition ReimbursementEOE Vet/Disability
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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