Sr Consultant - Operational Policies & Processes

Description & Requirements

Maximus is currently hiring for a Sr Consultant - Operational Policies & Processes.

This is a remote opportunity.

The Sr.

Consultant will play a critical role in developing, reviewing, and managing policies and procedures to support the IDR process under the No Suprises Act.

This individual will collaborate with the arbitration team and other stakeholders to ensure compliance with federal regulations, enhance process efficiencies, and support the resolution of payment disputes.

Essential Duties and Responsibilities:

- Provide advice, leadership and guidance to ensure appropriate determination of eligibility and processing of informal resolution.

- Guide the hearing, adjudication, complex or integrated teams to ensure all major requirements are met and relevant documents for appellant and hearing officer are captured accurately and according to Federal law and client requirements.

- Provide self-directed legal support to the project leadership.

- Provide direction, leadership, and training to production personnel on case management and case processing.

- Process and resolve high profile and complex appeals.

- Analyze projects, present data collection reporting and analysis management to client.

- Provide legal research and assistance for CMS/MAG on ACA regulations and appeal adjudications.

- Perform other duties as assigned by management.

- Arbitration Support: provide consultative support to the arbitration team, helping them navigate regulatory requirements, ensuring that dispute resolution is carried out in accordance with established guidelines, and assisting in the interpretation of IDR rulings.

- Policy Development & Maintenance: develop, review, and update policies and procedures related to the IDR process to ensure compliance with the No Surprises Act and other federal and state regulations.

- Documentation: maintain thorough documentation of all processes, policies and revisions.

- Training & Communication: develop and deliver training materials and communications to staff and stakeholders regarding policy updates, regulatory changes and procedural expectations for the IDR process.

- Collaboration: support and work closely with Payment Determination Manager, Training, Quality Assurance, and operations teams to ensure IDR process is operating effectively.

- Arbitration: Render payment determinations as needed by the business.

Process and resolve high profile and complex cases.

Minimum Requirements

- Bachelor's degree with 5-7 years of experience consulting within designated function.

- Advanced degree preferred.

- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.

- Ensure solutions are consistent with organization objectives.

- Solutions may serve as precedent for future decisions.

- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.

- Develop new applications based on pro...