Dispute Resolution Specialist

About the role

The Dispute Resolution Specialist will be the primary party responsible for research, strategy, communication, and all other matters related to Independent Dispute Resolution ("IDR"). The incumbent will coordinate efforts with the team and leadership to bring matters to efficient and successful outcomes. The Dispute Resolution Specialist will oversee the intake, processing and coordination of all materials and information as regulated by Federal or state law.

Responsibilities

• Prepare written analyses of disputed health plan positions and persuasively document arguments supporting client positions in arbitration packages pursuant to federal regulations.
• Conduct due diligence to assist with the analysis and preparation of arbitration packages.
• Work with other departments to develop or obtain information necessary for the submission of IDR packages.
• Review and analyze clinical information along with documents submitted by providers of moderate to high complexity.
• Meet federal filing deadlines and turnaround times.
• Maintain detailed and accurate records.
• Maintain department productivity and quality standards.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Any other duties or responsibilities related to IDR that may be otherwise required or assigned as necessary.

Required Experience/Education

Minimum 1 year of experience in healthcare operations relating to the No Surprises Act or Independent Dispute Resolution.

Skills and Abilities

• Excellent organizational, analytical and independent decision-making skills.
• Demonstrated problem solving skills with the ability to manage multiple priorities and meet associated timelines.
• Ability to anticipate needs and solve problems proactively in a fast paced, rapidly changing environment.
• Sound business judgement.
• Ability to learn quickly and work independently within time constraints.
• Adept knowledge of Microsoft Word, Excel and Outlook.
• Logical, clear and concise written and verbal communication skills.

Benefits

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives