Position:

Records (Reconsideration) Analyst II

Job Classification:

Late Enrollment Penalty Analyst

Location:

Remote

Position Type:

Non-exempt Full Time, possible overtime or weekend opportunity

Federal Mandate:

In accordance with federal mandate, must be able to provide proof of vaccination.

General Description:

J29 Inc. is looking for a Reconsideration Analyst II with skillsets ranging from abilities to freely operate on a computer, critical thinking, decision making experience, as well as a strong attentiveness to detail, to join our experienced team to continue delivery to our customers. J29 is a government-focused technology company that a history of strong performance for Federal and State agencies.

As a Records Analyst II, you will support our team in conducting review of Medicare appeals, as well as helping our team making reconsideration decision on these appeals. In support of CMS, you will be responsible for aiding our team in data entry and records decisions related to Late Enrollment Penalty (LEP) claims that involve Medicare Part D – the prescription drug benefit.

The Records Analyst II is responsible for performing moderately complex (journey-level) appeals work, as well as conducting Medicare Late Enrollment Penalty (LEP) decisions. This person will also work under moderate supervision, with moderate latitude for the use of initiative and independent judgement.

Duties:

• Drafts a non-medical LEP decision that is clearly written and understandable, comports with the Centers for Medicare & Medicaid Service (CMS) regulations and policy, and supports the evidence in the record.
• Investigates arguments of creditable coverage proffered by enrollees in support of removing a LEP for uncovered months; this includes reviewing enrollee appeal letters, reviewing documents furnished by enrollees in support of proof of creditable coverage, reviewing Part D plan case files, and calling enrollees, employers or other insurers, and Part D plans, as appropriate, to verify creditable coverage.
• Documents actions taken during the course of investigation and research into determining creditable coverage, e.g., documents telephone calls to enrollees or insurers and information relayed from these individuals.
• Determines whether there is good cause for late filing of an appeal by reviewing the enrollee appeal letters and case files submitted by plans to determine if there is good cause in accordance with Medicare rules and policy.
• Ensures that all appeal issues raised have been researched and addressed.
• Provides a fair and impartial decision based on the presentation of facts, CMS regulations and policies, other relevant information.
• Ensures all documents are releasable and do not violate any Privacy Act provisions.
• Conducts research using online CMS regulations and policy provisions, subscriber materials, and CMS system including the Eligibility and Enrollment Medicare Online (ELMO)to adjudicate decisions that are accurate and well-supported.
• Makes sound, independent decisions based on the evidence in the record in accordance with CMS regulations and policies, or subscriber materials.
• Stays abreast of changes in CMS rules, policies and other applicable guidance relative to LEP decisions.
• Participates in special projects and performs other duties as assigned.

Education Requirement:

• High School Diploma or equivalent

General Experience Requirement:

• Two (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

Skills and Abilities:

Some Knowledge of:

• Research techniques
• Medicare appeals program
• Applicable systems and applications
• Applicable laws, regulations and policies

Proficient skill in:

• Prioritizing and organizing work assignments
• The use of personal computers and applicable programs, applications and systems
• Communicating effectively verbally and in writing with Health Plans, Insurers and/or Medicare appellants

Some Skill in:

• Preparing correspondence and 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
• Assure compliance with regulatory, contractual and accreditation entries
• Use phone to call to obtain missing information or verify information, as needed

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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Work Location:

• Fully Remote

Job Type: Full-time

Pay: $15.00 - $17.00 per hour

Schedule:

• 8 hour shift
• Monday to Friday
• Overtime
• Weekend availability

COVID-19 considerations:
Remote work

Application Question(s):

• There are optional opportunities for weekend, holiday, or overtime hours - is this something that you would be interested in?
• Candidates that receive offer letters of intent to hire will be contingent on successful passing of a criminal background check and drug test passing. Please acknowledge your understanding of this.
• In accordance with Executive Order 14042, Federal covered contractors are requested to have a vaccinated workforce. Are you, or would you be willing to be vaccinated by your start date?

Education:

• Associate (Preferred)

Experience:

• general office: 2 years (Required)

Work Location: Remote

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