Overview
This position supports the arbitration team by leading the review and response to disputed out-of-network reimbursements submitted through state and federal arbitration processes. The position collaborates with other team members and leadership to process and manage an inventory of disputes during the open negotiation period / informal settlement period for arbitrations at both the state and federal levels.
Job Highlights
ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):
- Ensure all cases remain compliant with required response timelines and USAP input.
- Manage inventory of disputes regulated by Federal or State law during the open negotiation period / informal settlement period.
- Respond to Notice of offer requests using proprietary programs to calculate an offer.
- Analyze the offer to determine if it is within established thresholds to accept or reject.
- Negotiate with the non-initiating party or their representative to increase an offer that is below the threshold.
- Ensure offers and settlements are documented and tracked to deliver the required information for ongoing arbitration reviews and/or reporting.
- Communicate with the non-initiating party or their representative and IDREs, as needed to request or provide additional information
- Confirm that all documentation adheres to USAP standards regarding privacy, compliance, legal aspects, and HIPAA standards
- Model a collegial environment that fosters teamwork.
- Work cross-functionally with other managers and directors within USAP.
- Assist with special projects and perform other duties as assigned.
REPORTING TO THIS POSITION: No direct reports
Qualifications
JOB REQUIREMENTS (Knowledge, Skills and Abilities):
- Knowledge of all phases/steps of the arbitration process
- Knowledge of applicable state and federal requirements for arbitration
- Knowledge of IDX
- At least intermediate level in Word, Excel, and Outlook
- Possess and demonstrate analytical skills to make administrative and procedural decisions and use independent judgment.
- Communicate effectively, both written and verbal.
- Demonstrate ability to work cooperatively with employees, peers, senior leadership, physicians, and external customers.
- Proven strong attention to detail
- Ability to prioritize and organize work and projects to ensure focus on high-impact/value-added activities and meet deadlines.
- Ability to effectively work well under pressure in a fast-paced environment.
- Ability to recognize and effectively respond to urgent situations.
- Act decisively, making good ethical decisions based on analysis, experience, and judgment in a timely manner.
- Must display a positive “teamwork” attitude with strong interpersonal skills and possess a professional, pleasant disposition and tolerance for diverse personalities.
- Must demonstrate flexibility and ability to adapt to process changes as necessary to meet the needs and goals of the company.
- Must be able to work a flexible schedule, including occasional weekends
- Support department and organizational goals that contribute to the organization's success.
- Display self-accountability and embrace personal and professional growth and development.
- Willing to learn new processes. Self-motivated, with a sense of autonomy, initiative, and responsibility.
EDUCATION/TRAINING/EXPERIENCE:
- An associate’s degree in business administration or a health-related field is required, but a bachelor’s degree is preferred.
- 5 - 7 years of related experience with at least one year of anesthesia billing/posting/coding, etc.
- At a minimum, intermediate skill level in Word, Excel, and Outlook.
PHYSICAL REQUIREMENTS:
- Requires prolonged sitting, some bending, stooping, and stretching
- Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator and other office equipment
- Normal hearing range and eyesight are required to record, prepare, and communicate appropriate reports and evaluations.
- Requires lifting papers and boxes weighing up to 35 pounds occasionally
- Requires dexterity to type at least 35 wpm.
WORKING CONDITIONS (environment and safety):
- Remote work in an office environment is prominent for this role but may require on-site work.
- Must be able to work independently and may be required to sit or stand for long periods.
- Involves frequent contact with professional staff, managed care organizations, various Department of Insurance, and arbitrators.
- Work may be stressful at times.
- Interaction with others is frequent and often disruptive.
DISCLAIMER: The above job description has been written to indicate the general nature and level of work performed by employees within this classification. It is not written to be inclusive of all duties, responsibilities and qualifications required of employees assigned to this job.
Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.
