J29 Inc. is looking for a Records Analyst I with skillsets ranging from general office, data entry, critical thinking, and 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. J29 is happy to be continue delivering on improvements to the healthcare system at the Centers for Medicare and Medicaid Services (CMS).
As a Records Analyst I, you will support our team in conducting reconsiderations on Medicare 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. Part D can be offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with your Medicare Advantage Plan.
The Records Analyst I is responsible for performing routine administrative appeals work, and serving as a support person for the decision-maker for Late Enrollment Penalty (LEP) cases. This person will also work under close supervision, following work instructions, with minimal latitude for the use of initiative and independent judgement.
General Experience Requirement:
- One (1) + years of general office experience and/or business administrative abilities
- College education or technical training in administration, business, or related areas may be substituted for experience. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
- High School Diploma or equivalent
- 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.
Skills and Abilities:
Basic Knowledge of:
- Research techniques
- Medicare appeals program
- Applicable systems and applications
- Applicable laws, rules and regulations
Basic Skill in:
- Preparing correspondence/documents using correct spelling, grammar and punctuation; proofreading and reviewing documents for clarity and consistency
- Prioritizing and organizing work assignments
- The use of personal computers and applicable programs, applications and systems
- 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 various stakeholder groups
- Show integrity and ethical behavior; respect confidentiality, business ethics and organizational standards
- Assure compliance with regulatory, contractual and accreditation entries
Type of Work
- Temporary (3-5 months) with chance of permanent placement; Official start date is Thursday, January 4th 2024
- Remote: US Based
- CMS regulation require US Residence 3 of the past 5 years.