https://www.c2cinc.com/
Please visit our Career Center to Apply and View the Full Job Description!
https://jobs.tmf.org/
**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 United States*
Position Purpose
- 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.
Writes, and may plan, 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 and Medicaid Services (CMS) policy, and local Medicare policy, or other authoritative sources.
Ensures, and may plan, that all appeal issues raised by the beneficiary, representative, and supplier have been addressed.
Provides a fair and impartial decision.
Conducts research using online federal regulations, Medicare Administrative Contractor (MAC) policy, standards of medical practice, CMS contractor manuals, coverage issues manuals, and medical literature to complete an accurate and well-supported decision.
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
Five (5) to 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)
Resided in the United States for a minimum of three (3) years out of the last five (5) years? (Per Contract Requirement)
Benefits
C2C offers an excellent benefits package, including:
[]{style="font-size: 7pt; font-family: 'Times New Roman'; font-weight: normal; font-stretch: normal
"}
About the company
Company website•Hospitals and Health Care
Improving Lives by Improving the Quality of Health Care
TMF Health Quality Institute focuses on promoting quality health care through contracts with federal, state and local governments, as well as private organizations. For more than 50 years, TMF has helped health care providers and practitioners in a variety of settings improve care for their patients.
TMF was chartered in 1971 as a private, nonprofit organization of licensed physicians (MDs and DOs) to lead quality improvement and medical review efforts in Texas. Originally known as the Texas Medical Foundation, the company changed its name to TMF Health Quality Institute in 2005 to reflect the expansion of its work throughout the nation.
In 2011, TMF acquired C2C Innovative Solutions, Inc., a Medicare Qualified Independent Contractor with offices in Florida and employees throughout the nation. This acquisition expanded TMF’s scope of services and increased our presence in the government contracting market. C2C specializes in providing health care sector support and administrative services in the handling of Medicare second-level appeals.
In 2013, TMF established the TMF Foundation in support of TMF’s vision to improve lives by improving the quality of health care. The TMF Foundation provides resources and educational support to organizations focused on the health of Texas residents. Recently, the foundation joined an effort to affect the trend of childhood obesity.
We partner with health care providers in multiple settings:
•Hospitals
•Physician Offices
•Nursing Homes
•Home Health Agencies
•Medication Safety and Reduction of Adverse Drug Events
TMF partners with health care providers to ensure that every patient receives the right care… every time.