[Remote] Dispute Resolution Specialist II
Note: The job is a remote job and is open to candidates in USA. Claritev is a dynamic team of innovative professionals striving to bend the cost curve in healthcare. The Dispute Resolution Specialist II will manage an arbitration case load, evaluate provider disputes, and coordinate the resolution of complex escalated issues while ensuring compliance with applicable regulations.
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
Skills
- 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
- Bachelors' degree in a related field
Benefits
- 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
Company Overview
- Claritev is an independent and public healthcare technology, data and insights company making healthcare more transparent, fair and affordable for all. It was founded in 1980, and is headquartered in Mclean, Virginia, USA, with a workforce of 1001-5000 employees. Its website is https://www.claritev.com/.
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