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Senior Consultant - Policy and Process The candidate will identify the legal, factual and policy issues to be addressed in Medicare administrative appeals. Research issues and write job aides, and maintain subject matter expertise in Medicare DME coverage policies. Evaluate appeals decision, advise on the interpretation and application of Medicare laws and regulations and provide strategies to promote consistency in the appeals process and reduce the number of claim reversals. Conduct initial and routine training with Appeal Associate/Consultants on policy related subjects and/or coverage rules. Maintain updated library of adjudication practices. Review and assess quality of appeal outcomes. Coordinate Medicare contractors’ efforts to ensure CMS perspective is represented effectively at ALJ hearings. Perform other duties as assigned by leadership. Must have JD degree or equivalent experience. Should have 7+ years of experience in government agency or corporation environment or applicable experience. Experience in Medicare work Part A, B and DME is preferred. Experience with a Medicare program is desired. Demonstrated excellent research and writing skills is required.
Requisition ID: 2017-25945
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