Primary Purpose:

This individual will assist the Appeal’s Manager with all activities required to timely and accurately file all Tenet Healthcare individual and group appeals with the Provider Reimbursement Review Board (PRRB) and the Medicare Administrative Contractors (MACs) as well as addressing all cost report reopenings.

Key Responsibilities:

• File individual and group appeals with the PRRB and MAC’s.
• File cost report reopenings with the MAC’s and present documentation in an attempt to resolve the issues presented.
• Research issues appealed for preparation of preliminary and final position papers that are submitted to the PRRB and MAC in an attempt to resolve issue(s) presented.
• Prepare and update appeal and reopening logs to ensure PRRB and MAC filing timeframes are met.
• Work with outside attorneys and/or consultants for individual and group appeal cases assigned to them for representation.

Qualifications:

Requires Bachelor Degree in Accounting or Business.

Required Knowledge:

The position requires a working knowledge –

• The Medicare Cost Report, the Medicare Regulations and Provider Reimbursement Manual.
• The Provider Reimbursement Review Board process and appeal filing requirements.
• The MACs reopening filing requirements.
• Ability to work with Tenet hospital Controllers/CFOs and staff to obtain any additional documentation need to support an appeal or reopening.

ompensation

• Pay: $89,440.00-$120,000.00 annually. Compensation depends on location, qualifications, and experience.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

The following benefits are available, subject to employment status:

• Medical, dental, vision, disability, life, AD&D and business travel insurance
• Paid time off (vacation & sick leave)
• Discretionary 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
• For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act is available.

Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

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