Coordinator 2 - Arbitration

Essential Duties and Responsibilities:

Function as a Subject Matter Expert in one or more process areas.

- Analyze data submitted for Independent Medical Review.

- Conduct fact finding and analyses on those cases deemed complex in nature or requiring adjudication; apply established procedures where the nature of the system, feasibility, computer equipment and reporting tools have not already been decided.

- Track and meet required deadlines for complex cases or other assigned tasks.

- Assist leadership through research of data and/or authoring reports.

- Analyze data using all applicable state law, state regulations, process documents, and other sources as defined by the client contract.

- Work independently on specific situations or on a team to resolve problems and deviations according to current established practices; and obtains advice where precedents are unclear or not available from the client.

- Answer and respond to phone calls/emails from participants in the Independent Medical Review process.

- Assist others or provide on-the-job training or act as a mentor to production staff.

- Review and interpret Explanation of Benefits (EOBs), HCFA/CMS-1500 claim forms, UB-04 forms, and other healthcare-related documentation.

- Analyze eligibility information and make accurate eligibility determinations based on applicable guidelines, regulations, and case-specific facts.

- Identify discrepancies, inconsistencies, and missing information across multiple sources of documentation.

- Research and evaluate complex cases that require independent judgment and problem-solving.

Minimum Requirements

- High School Degree or equivalent required.

- 2-4 years of related professional experience required.

- Strong knowledge of healthcare claims processing, including EOBs, HCFA/CMS-1500 claim forms, and related billing documentation.

- Demonstrated ability to make eligibility determinations using critical analysis and independent judgment.

- Strong analytical and investigative skills with the ability to connect information from multiple sources.

- Ability to think beyond linear processes and navigate complex scenarios where information may be incomplete or conflicting.

- Excellent attention to detail, organizational skills, and decision-making abilities.

- Ability to work a schedule between the hours of 8:00am - 5:30pm EST Monday - Friday required.

Please note: For this position Maximus will provide equipment to use.

Home Office Requirements:

- Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)

- Minimum 5mpbs upload speed

- Connectivity to the internet via Category 5 or 6 ethernet patch cable to the home router

- Private and secure work area and adequate power source

- Must currently and permanently reside in the Continental US

- Must have a smartphone which will be required to log into Maximus systems

EEO Statement

Maximus is an equal opportu...