The ISSO II will document security policies and practices according to the Risk Management Framework for federal and state systems. They are responsible for assessing security measures, identifying vulnerabilities, and maintaining incident response and disaster recovery plans.
The Claims Review Nurse will conduct initial assessments of claim documentation and collaborate with clinical professionals to determine the medical necessity of services. They are responsible for drafting determination letters and facilitating the resolution of disputes between healthcare providers, patients, and payers.
The Help Desk Operator handles inbound and outbound communications to resolve routine customer inquiries and issues for DEA registrants. They are responsible for maintaining accurate documentation and escalating complex problems to senior staff while meeting performance metrics.
The Arbiter is responsible for reviewing and deciding payment disputes by analyzing documentation and applying federal law and contract regulations. They must draft concise, well-supported determinations while managing complex case files within strict deadlines.
The attorney will evaluate Workers' Compensation Medicare Set-aside Arrangement (WCMSA) proposals to project future medical costs in accordance with CMS guidelines. They will also review medical records to ensure proposals meet Medicare threshold requirements and adequately consider beneficiary needs.
Resolve claim disputes submitted by healthcare providers, hospitals, and pharmacies. Provide professional assistance to health care plans and providers to reach claim resolutions.
