Dispute Resolution Analyst I

J29, Inc•Millersville, MD

9h•$16 - $18•Remote

About The Position

J29, Inc. is hiring a Dispute Resolution Analyst to support Independent Dispute Resolution (IDR) programs handling routine Surprise Billing appeals. The analyst supports reconsideration and dispute resolution professionals and physician reviewers with second-level reconsiderations and dispute resolutions. The position works under close supervision, with minimal latitude for initiative and independent judgment.

Requirements

One year of experience with provider disputes or claims.
One year of interaction with claims involving larger insurance plans.
One year of general office or administrative experience.
High school diploma or equivalent.

Nice To Haves

Experience directly relevant to the specific task order or project.

Responsibilities

Coordinate delivery of re-determination files, dispute resolution documents, and reconsideration or dispute resolution decisions to and from external entities.
Build case files from submitted and received evidence and analyze cases to ensure requests meet applicable CMS or other customer requirements.
Analyze cases and make decisions based on medical versus non-medical case type, appeal or review category, request validity, and settlement documentation.
Enter appropriate case data into required systems.
Respond to reconsideration and dispute review requests from appellants, patients, and providers.
Route or respond to telephone and written inquiries about reconsiderations, dispute resolutions, and related processes from appellants, patients, or their legally designated representatives.
Identify suspected fraud or abuse and promptly inform management.
Stay current on changes in regulations, practices, policies, and procedures.
May request re-determination files and completed reconsideration and Administrative Law Judge decisions from relevant entities.
Participate in special projects and perform other assigned duties.