DRR III Position Available In Duval, Florida

Salary Confidential
Position range in Jacksonville, FL Metropolitan Statistical Area $35k – $54k Per Year DRR III
C2c Solutions, Inc.

Occupation:

Healthcare Support Workers, All Other

Location:

Jacksonville, FL – 32202
Positions available: 1
Job #: 12482932

Source:

Employ Florida

Posted:

4/24/2025

Updated:

4/25/2025

Expires:

6/23/2025

Web Site:

Employ Florida
Onsite /

Remote:

Work at home all of the time

Job Type:

Regular, Full Time (30 Hours or More), Permanent Employment Job Requirements and Properties Help for Job Requirements and Properties. Opens a new window. Job Requirements and Properties Help for Job Requirements and Properties. Opens a new window. AD 36 Job Description Help for Job Description. Opens a new window. Job Description Help for Job Description. Opens a new window. 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:

Provides dissatisfied patients/beneficiaries and/or providers the opportunity to present documentation to demonstrate why an appeal/dispute should be allowed. Provides an independent second level determination/dispute resolution based on the documentation, facts, laws, regulations, and guidelines.

Essential Responsibilities:

Reviews medical records/case file, writes a reconsideration/dispute resolution decision that is clear, concise, and impartial and supports the determination made, and documents review.
Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, and policy.
Responds to and ensures that all appeal/dispute issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision.
Stays abreast of changes in regulations, medical and healthcare practices, policies and procedures. Minimum Qualifications Education Associate’s degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate’s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.) Experience Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or related experience in a healthcare setting
Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
Juris Doctorate or Master’s Degree in Healthcare or related discipline may be substituted for Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
Demonstrated experience writing or making appeal or payment determinations
Patient- Provider Dispute Resolution, preferred
Independent Dispute Resolution, preferred
Coding certificate, 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 Help for Employer Information. Opens a new window.