Dispute Resolution Specialist II

Claritev•New York, NY

1d•Onsite

About The Position

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 to oversee and manage the intake, processing and coordination of all materials and information relating to the Independent Dispute Resolution ("IDR") as regulated by Federal or State law. 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.

Requirements

Minimum high school diploma or equivalent (GED) and four (4) years' experience in healthcare operations.
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

Nice To Haves

Bachelors' degree in a related field is preferred.

Responsibilities

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.
Outreach to clients for data needed for arbitration packages
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.
Demonstrate Company's Core Competencies and values held within.
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.

Benefits

health insurance
401k
bonus opportunity
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
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