Dispute Resolution Specialist II

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.
The incumbent's primary responsibility will be responding to oversee and manage the intake, processing and cooridination of all materials and information relating Independent Dispute Resolution ("IDR") as regulated by Federal or state law.
JOB ROLES AND RESPONSIBILITIES: 1.
Assume primary responsibility for determining appropriate amount of client plan arbitration offers.
2.
Draft briefs and offers persuasively documenting arguments supporting client positions in arbitration packages pursuant to federal regulations.
3.
Conduct due diligence (e.
g.
online research, portal and application research) to assist with the analysis and preparation of arbitration packages.
4.
Works with other departments to develop or obtain information necessary for the submission of IDR packages.
5.
Review and analyze clinical information along with documents submitted by providers of moderate to high complexity.
6.
Meet federal filing deadlines and turn around times 7.
Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; maintain detailed and accurate records.
8.
Outreach to clients for data needed for arbitration packages 9.
Maintain department productivity and quality standards 10.
Sensitivity to privacy in accordance with HIPAA guidelines 11.
Collaborate, coordinate, and communicate across disciplines and departments.
12.
Ensure compliance with HIPAA regulations and requirements.
13.
Demonstrate Company's Core Competencies and values held within.
14.
The position responsibilities outlined above are in no way to be construed as all encompassing.
Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE: Keep the needs of external and internal customers as a priority when making decisions and taking action.
Operates independently under limited supervison.
Has decision making authority to determine the appropriate amount of clients' offers and drafting of briefs.
Works across customers, beneficiaries, providers, and suplimental payors while maintaining positive relationships.
JOB REQUIREMENTS (Education, Experience, and Training): * Minimum high school diploma or equivalent (GED) and four (4) years' experience in healthcare operations.
Bachelors' 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 * 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 * Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.