Coordinator 2 - Appeals - integrated resources : Job Details

Essential Duties and Responsibilities: - Analyze data submitted for Independent Medical Review. - Conduct fact finding and analyses on those cases deemed complex in nature or requiring adjudication; apply established procedures where the nature of the system, feasibility, computer equipment and reporting tools have not already been decided. - Track and meet required deadlines for complex cases or other assigned tasks. - Assist leadership through research of data and/or authoring reports. - Analyze data using all applicable state law, state regulations, process documents, and other sources as defined by the client contract. - Work independently on specific situations or on a team to resolve problems and deviations according to current established practices; and obtains advice where precedents are unclear or not available from the client. - Answer and respond to phone calls/emails from participants in the Independent Medical Review process. - Assist others or provide on-the-job training or act as a mentor to production staff. **********Minimum Requirements: - High School Degree or equivalent required. - 2-4 years of related professional experience required. THIS POSITION IS CONTINGENT UPON CONTRACT AWARD We are a contractor with the Centers for Medicare and Medicaid Services (CMS). This position entails working on an appeals program within our Adjudication Team and will review Medicare Appeals for Medicare Part C and Medicare Part D. This role will triage appeals, perform research as applicable, and render technical decisions for the respective program. This position will require strong verbal and written communication skills and will involve phone outreach to various entities such as physician offices and beneficiaries. To read more information on the overall appeals process you can review items on CMS' website under Appeals - Medicare Advantage (Part C), or Prescription Drug Appeals (Part D). Training for this role will begin prior to the contract award and the longevity of this position is contingent on contract award. In the event the contract is not awarded, the candidate will be evaluated for alternate roles as applicable. Must be US Citizen and/or have lived in the US for the last 5 years, with continuous work for the past 3 years. All employees will go through a Personal Identity Verification completed by CMS Federal Check along with *** Background Check. dditional Information: Start Date: 09/02/2025 # of Positions - 12 Project Name: QIC Part D Pay Rate: *** Type: Temp to Perm Training Schedule: Up to one week of training and then nesting. The candidates who work the Sun-Thurs; Tues-Sat, will work Mon-Fri during training period and nesting. Training dates 9/2/2025 9/8/2025 9/15/2025 9/22/2025 9/29/2025 10/6/2025 10/13/2025 Hours of Operations: 8 positions - M-F See Specific Times - Mon-Fri Shifts below 2positons - Sun-Thurs 8:30-5 2 positions- Tues-Sat 8:30- 5 Specific times Monday - Friday Shifts for All positions: 7:00 - 3:30 7:30 - 4:00 8:00 - 4:30 8:30 - 5:00 9:00 - 5:30 9:30 - 6:00 Sunday - Thursday: Sun 7:00 - 3:30 Sun, than 8:30 - 5:00 weekdays (EST) Tuesday - Saturday: Sun - 7:00 - 3:30 Sat, than 8:30 - 5:00 weekdays (EST) Saturday and Sunday hours may be changed to as early as 7:00 a.m. Project works 7 days a week including Holidays Resume: Must included the schedule your candidate wants to work; please let them know there are the limited schedules so they might have to be flexible Type: Temp to Perm Background: Can start once MedScan clears; Will also be required to have a Federal CMS background check; results could take up to 6-8 weeks. Equipment: Day one of training AWS will be added to their equipment; Upon Contract Win, a *** Computer will be sent to them Interview Process: TEAMS