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Dispute Resolution Analyst

  • TMF Health Quality Institute
  • Remote, Anywhere US
  • Mar 31, 2025
Full time Health Care

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:

Serves as a support person for the reconsideration/dispute resolution professionals and physician reviewers for second level reconsiderations/dispute resolutions.

 

Essential Responsibilities:

  • Coordinates the delivery of re-determination files/dispute resolution documents and reconsideration/dispute resolution decisions from and to the external entities.
  • Builds a reconsideration/dispute resolution case file from evidence submitted and received and analyzes each case to ensure it meets the requirements for a valid reconsideration/dispute resolution request as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities.
  • Analyzes and makes decisions based on medical vs. non-medical case type, appeal/review categories, validity of appeal/dispute resolution request, and dispute resolution settlement documentation.
  • Inputs appropriate data regarding reconsiderations/dispute resolution cases into the applicable required systems.
  • Responds to reconsideration/dispute review requests from appellants/patients/providers.

 

 

Minimum Qualifications

 

Education

  • High School Diploma or equivalent

 

Experience

  • One (1) year of general office experience
    • College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
  • Independent Dispute Resolution (IDR), 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

 

About TMF Health Quality Institute

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.

TMF’s programs and services—ranging from quality improvement consulting and technical assistance to research, data analysis and medical review—engage all aspects of health care. Our programs have worked directly with thousands of physicians and other health care providers across the United States, affecting millions of people from children to senior citizens.

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