Consultant Eligibility Contractor Review 240822

POSITION DESCRIPTION: The Eligibility Consultant will be responsible for reviewing incoming eligibility request forms under the Alexander v. Azar retrospective review process to determine validity of requests for further eligibility and appeals review.

This position will solely support the scope of work for the Eligibility Contractor period of performance only. The period of performance is slated to run for approximately 18 months. Position is contingent upon contract award.

JOB RESPONSIBILITIES:

· Perform validity reviews of requests for retrospective appeals associated with Medicare denials of Part A coverage of hospital stays.

· Respond to requests for retrospective appeal with detailed letters based on review findings.

· Monitor timeliness of reviews to ensure required CMS standards are attained.

· Coordinate and assist in the development and maintenance of written procedures for consistency of reviews and training of any required personnel.

· Meet or exceed all performance standards established for this position.

· Performs other duties as may be assigned by management.

EDUCATION/EXPERIENCE:

· Two-year degree required, four-year degree preferred.

· Two years’ experience in Medicare Part A and Part B of A preferred.

· Working knowledge and use of PC. Proficiency with Microsoft Word and Excel.

· Strong organizational, written, and verbal communication skills.

· Ability to perform comfortably in a fast-paced, deadline-oriented work environment.

· Ability to successfully execute many complex tasks simultaneously.

· Ability to maintain confidential and sensitive information.