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Job Title: CWF Auditor
Job Location: NY: New York City
Pay Rate: Open
Job Length: full time
Start Date: 2008-09-19

Company Name: GHI
Contact: Recruiter
Phone: email only please
Fax: email only please

Description: CWF Auditor COMPANY: HIP LOCATION: Hollywood Florida

HOURS:

DEPT:

Description of Duties * Investigate and make discretionary decisions to resolve disputes received from Medicare Contractors, Regional Offices, Managed Care Organizations and Congressional offices relating to data applied to the CWF file. Audit and assure the validity of the records on the CWF File, which includes securing additional information via telephone or by sending a request in writing. ? Initiate calls to the Medicare Contractors and Regional Offices to resolve disputes or further develop a MSP situation. ? Handle inquiries and calls from CMS Regional Office Staff escalated from the Customer Service Department and through the Electronic Correspondence and Referral System (ECRS). ? Maintain the integrity of the Medicare Secondary Payer (MSP) records that are housed at CWF. These records are viewed by all Medicare Contractors in the United States to determine primacy of payment. This includes using discretionary decision making to resolve and close invalid or inappropriate records that may exist in the CWF. ? Ensure timely processing of Workers? Compensation Medicare Set-Aside (WCMSA) cases. Review and validate the cases through the Workers? Compensation Case Control System (WCCCS). Develop any missing information via telephone or sending a request in writing. ? Review and finalize, using discretionary decision making skills, Suspended Transactions and Inquiries from various work types due to conflicting information with an existing CWF record. ? Review and finalize, using discretionary decision making skills, Suspended Call Back Phone Logs received from the COB Call Center. Perform extensive analysis and/or studies when required. Determine if there is sufficient information to update the CWF file based on information supplied. If additional information is needed, obtain through utilizing system and business resources, e.g., CMS Regional Office staff, Congressional Offices, and Medicare contractors. ? Prepare written responses reporting the details of an investigation or resolution of a case to attorneys, employers, insurers, Congressional Offices, and Medicare Contractors in accordance with the Health Insurance Portability and Accountability Act and Internal Revenue Services rules and regulations regarding confidentiality of information.

Requirements * Education/Experience: The ideal candidate will possess an Associates Degree and three years of business experience. A minimum of two years of demonstrated excellence in a customer service capacity is required. Additional experience may be considered in lieu of degree requirement. * Skills/Knowledge/Competencies: The ideal candidate must possess in-depth knowledge of Medicare regulations, including knowledge of Medicare Secondary Payer (MSP) guidelines. Experience with Microsoft applications is required. Strong oral and written communication skills sufficient to clearly articulate business matters and effectively communicate with internal and external customers are required. Demonstrated ability to analyze information and make independent decisions is essential. The qualified candidate must be highly organized and have the ability to prioritize a heavy workload in a dynamic, fast paced environment, to include working under stringent deadlines.

Please refer to Job code ghi-1797 when responding to this ad.

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