Dispute Resolution Specialist II

Pay

Pay range $19-21

Job Summary

This role manages an arbitration case load including evaluation of provider disputes and appropriate client payment offers. This position is responsible for successful analysis and resolution of the most complex escalated issues. The incumbent will coordinate efforts with the team and leadership to bring matters to efficient and successful outcomes.

Duties

• Assume primary responsibility for determining appropriate amount of client plan arbitration offers.
• Draft briefs and offers persuasively documented arguments supporting client positions in arbitration packages pursuant to federal regulations.
• Conduct due diligence (e.g. online research, portal and application research) to assist with the analysis and preparation of arbitration packages.
• Works 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
• Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; maintain detailed and accurate records.
• Maintain department productivity and quality standards
• Sensitivity to privacy in accordance with HIPAA guidelines
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.

Job Scope

Keep the needs of external and internal customers as a priority when making decisions and taking action. Operate independently under limited supervision. Has decision making authority to determine the appropriate amount of clients' offers and drafting of briefs. Works across customers, beneficiaries, providers, and supplemental payors while maintaining positive relationships.

Compensation

The salary range for this position is $19-21 per hour. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Requirements

• Minimum high school diploma or equivalent (GED) and four (4) years' experience in healthcare operations.
• Bachelor's degree in a related field is preferred.
• 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.
• Adept knowledge of Microsoft Word, Excel and Outlook.
• Logical, clear and concise written and verbal communication skills.

Job Scope

Your Benefits Will Include Medical, dental and vision coverage with low deductible & copay
Life insurance
Short and long-term disability
Paid Parental Leave
401(k) + match
Employee Stock Purchase Plan
Generous Paid Time Off - accrued based on years of service
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
10 paid company holidays
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Sick time benefits - for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits

EEO Statement

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.