Overview
Position is responsible for the day-to-day submission of out-of-network disputes utilizing the dispute resolution process utilizing the State or Federal independent dispute resolutions processes, known as “arbitration”.
At this time, US Anesthesia Partners does not hire candidates residing in New York, California, Hawaii, or Alaska.
Job Highlights
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Monitor arbitration deadlines to ensure compliance.
- Manage inventory of assigned disputes regulated by Federal or State law.
- Follow arbitration team pathways and standards.
- Learn the State and Federal arbitration guidelines associated with assigned cases.
- Support the Notice of Open Negotiation process for Federal disputes.
- Support the filing of disputes/arbitrations utilizing Department of Insurance portals for State disputes, or the CMS portal for Federal disputes.
- Confirm required data to support dispute/arbitration submissions is available for timely and accurate submission.
- Ensure that all responses/correspondence submitted for disputes/arbitrations are filed timely and responded to.
- Respond to correspondence as directed by management.
- Address and research inquiries from arbitrators when applicable.
- Provide research and answers to questions and concerns
- Maintain electronic case file and documents to be retained for each dispute/arbitration.
- Communicate regularly with arbitration management team on identified trends, issues, concerns, deadlines, etc.
- Act as point of contact support for management on assigned cases.
- Maintain productivity and quality standards.
REPORTING TO THIS POSITION: No direct reports.
Qualifications
JOB REQUIREMENTS (Knowledge, Skills and Abilities):
- Advanced level skill in computer applications including MS Word, MS Excel.
- Advanced knowledge of managed care programs and healthcare billing. Anesthesia experience preferred.
- Must display teamwork attitude and good inter-personal skills.
- Ability to communicate effectively in writing.
- Ability to work independently with limited supervision.
- Willing to learn new processes.
- Knowledge of basic medical terminology and concepts preferred.
- Knowledge of CPT, ICD-9, and ASA coding preferred.
- Must be able to work a flexible schedule, including occasional weekends
- Organized with 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.
- Assist with special projects and perform other duties as assigned.
EDUCATION/TRAINING/EXPERIENCE:
- High school diploma or equivalent.
- 3 – 4 years of related experience.
- Excellent written and verbal communication skills.
- Intermediate skills in Microsoft Word and Excel is required
- Ability to be detail oriented and organized with ability to prioritize.
- Prior collections experience and/or phone work is a plus.
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
- Required normal range of hearing and eyesight 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):
- Work performed in office environment
- Involves frequent contact with professional staff and managed care organizations
- 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.
US 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
