-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Boise, US-ID
Salary / Rate: 99000
Posted: 2024-04-20 08:29:53
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Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Jacksonville, US-FL
Salary / Rate: 99000
Posted: 2024-04-20 08:29:53
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Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Tampa, US-FL
Salary / Rate: 99000
Posted: 2024-04-20 08:29:52
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Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Savannah, US-GA
Salary / Rate: 99000
Posted: 2024-04-20 08:29:52
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Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Tallahassee, US-FL
Salary / Rate: 99000
Posted: 2024-04-20 08:29:51
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Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Miami, US-FL
Salary / Rate: 99000
Posted: 2024-04-20 08:29:51
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Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Atlanta, US-GA
Salary / Rate: 99000
Posted: 2024-04-20 08:29:50
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Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Denver, US-CO
Salary / Rate: 99000
Posted: 2024-04-20 08:29:49
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Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Bridgeport, US-CT
Salary / Rate: 99000
Posted: 2024-04-20 08:29:49
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Sacramento, US-CA
Salary / Rate: 99000
Posted: 2024-04-20 08:29:48
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Wilmington, US-DE
Salary / Rate: 99000
Posted: 2024-04-20 08:29:48
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Colorado Springs, US-CO
Salary / Rate: 99000
Posted: 2024-04-20 08:29:47
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Dover, US-DE
Salary / Rate: 99000
Posted: 2024-04-20 08:29:46
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Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Hartford, US-CT
Salary / Rate: 99000
Posted: 2024-04-20 08:29:45
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Los Angeles, US-CA
Salary / Rate: 99000
Posted: 2024-04-20 08:29:44
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Fort Smith, US-AR
Salary / Rate: 99000
Posted: 2024-04-20 08:29:43
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: San Francisco, US-CA
Salary / Rate: 99000
Posted: 2024-04-20 08:29:42
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: San Diego, US-CA
Salary / Rate: 99000
Posted: 2024-04-20 08:29:40
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Little Rock, US-AR
Salary / Rate: 99000
Posted: 2024-04-20 08:29:39
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Tucson, US-AZ
Salary / Rate: 99000
Posted: 2024-04-20 08:29:38
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Montgomery, US-AL
Salary / Rate: 99000
Posted: 2024-04-20 08:29:37
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Mobile, US-AL
Salary / Rate: 99000
Posted: 2024-04-20 08:29:36
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Phoenix, US-AZ
Salary / Rate: 99000
Posted: 2024-04-20 08:29:35
-
Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers.
It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time.
Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school.
Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- Excellent organizational, interpersonal, written, and communication skills.
- Ability to work as a team member, as well as independently.
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred.
Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment....
....Read more...
Type: Permanent Location: Birmingham, US-AL
Salary / Rate: 99000
Posted: 2024-04-20 08:29:34
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Description & Requirements
Maximus is currently looking for a Clinical Administrative Coordinator to support the Michigan QRTP and Ohio PASRR programs.
The Clinical Administrative Coordinator will handle administrative tasks such as answering phone calls, email follow ups, and scheduling.
*
* This is a remote position
*
*
Must be willing and able to work the following schedule: Monday - Friday from 9:00 am to 6:00 pm Central Standard Time.
Essential Duties and Responsibilities:
- Provide high level customer support to internal and external customers.
- Responsible for assigning and coordinating referrals for contract work to appropriate parties
- Computer data entry
- Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures.
- Complete assignments within established compliance standards and timelines
- Monitor multiple work queues daily to ensure cases move quickly through each process stage.
- Identify and resolve data errors
- Performs other related duties as assigned.
- Excellent written and verbal communication skills
- Excellent interpersonal and customer service skills
- Proficient in Microsoft Office Suite
- Excellent organizational skills and attention to detail
- Ability to work in a fast-paced environment
- Ability to work independently
Minimum Requirements
Minimum Requirements:
- High School Degree or equivalent and minimum 2 years of relevant experience, or Associate Degree with minimum 1 year or relevant experience
- Clinical office experience preferred
Program Specific Requirements:
- High school diploma or equivalent required
- Proficiency in Microsoft Office required
- Experience creating and maintaining scheduling for multiple people preferred
- Clinical Administrative experience preferred
- Ability to multi-task and change direction midstream
- Highly organized
Home Office Requirements:
- Maximus provides company-issued computer equipment
- Reliable high-speed internet serviceMinimum
- 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
- Minimum 5 Mpbs upload speeds
- Private and secure workspace
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce.
We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resource.
Maximus is an Affirmative Act...
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Type: Permanent Location: Eau Claire, US-WI
Salary / Rate: 17.5
Posted: 2024-04-20 08:29:33
