Dispute Resolution Specialist II

Dispute Resolution Specialist II

 

Pay range $19-21

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

 

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 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.

 

 

DUTIES

1. Assume primary responsibility for determining appropriate amount of client plan arbitration offers.
   2. Draft briefs and offers persuasively documented 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 turnaround 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. 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.

 

 

Qualifications

REQUIREMENTS

* 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 requi