Dispute Resolution Specialist in Work From Home at MultiPlan

Date Posted: 9/3/2022

Job Snapshot

Job Description

JOB SUMMARY: This role manages an arbitration case load including evaluation of provider disputes and appropriate client payment offers. 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. Prepare written analyses of disputed provider/health plan positions and persuasively document arguments supporting client positions in arbitration packages pursuant to federal regulations.
2. Conduct due diligence (e.g. online research, portal and application research) to assist with the analysis and preparation of arbitration packages.
3. Works with other departments to develop or obtain information necessary for the submission of IDR packages.
4. Review and analyze clinical information along with documents submitted by providers of moderate to high complexity.
5. Meet federal filing deadlines and turn around times
6. Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; maintain detailed and accurate records.
7. Outreach to clients for data needed for arbitration packages
8. Maintain department productivity and quality standards
9. Sensitivity to privacy in accordance with HIPAA guidelines
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate Company's Core Competencies and values held within.
13. 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 supervision. Has decision making authority within specified parameters and must engage with manager for advice and/or help to proactively resolve cases. Works across customers, beneficiaries, providers, and supplemental payors while maintaining positive relationships.
**Pursuant to Colorado’s “Equal Pay for Equal Work Act”, the following salary range is provided solely for applicants living in Colorado.  $43,000-$45,000.  If an applicant does not live in Colorado, this salary range may not apply.  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.

Job Requirements

JOB REQUIREMENTS (Education, Experience, and Training):
* Minimum high school diploma or equivalent (GED) and two (2) years' experience in healthcare operations. Bachelors' degree in a related field is preferred plus two (2) 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


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.

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