Job Description

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 Anywhere US* Position Purpose: Performs highly advanced (senior-level) work. Provides dissatisfied beneficiaries and/or providers/suppliers the opportunity to present documentation to demonstrate why an appeal should be allowed. Provides a denovo independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Participates in Administrative Law Judge (ALJ) hearings as a party witness. Works under minimal supervision, with considerable latitude for the use of initiative and independent judgement. Essential Responsibilities: Plans, prepares for and participates in ALJ hearings by providing written position papers, oral support or testimony as required. Plans and reviews cases to determine the appropriate defense. Plans, prepares for, and defends a reconsideration decision by presenting at the ALJ hearing by telephone. Plans and provides medical support to the ALJ team. Plans and writes a reconsideration decision that is clear and supports the determination made. Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, Centers for Medicare & Medicaid Services (CMS) policy, and local Medicare policy, or other authoritative sources. Plans and ensures that all appeal issues raised by the beneficiary, representative, and supplier have been addressed. Minimum Qualifications Education Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited Medical School License and Certification Active State license to practice medicine Board certification Experience Seven (7) years of clinical or direct patient care No federal or state sanctions as would appear on reporting from the National Practitioner Data Bank (NPDB) Currently have or have had direct patient care within the last three years Medicare, preferred 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 401K Competitive salary License/credentials reimbursement Tuition Reimbursement EOE Vet/Disability Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c) TMF Health Quality Institute

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