Dispute Resolution Analyst I

J29, Inc; United States; À distance; USD 22 000 - 25 000; Plein temps

Résumé du poste

J29, Inc. is seeking a Dispute Resolution Analyst to support the IDR program, handling re-determination files, dispute resolution decisions, and related documentation in a remote healthcare environment.

The role requires attention to detail, the ability to analyze medical vs non-medical cases, and experience with CMS guidelines. You will collaborate with reviewers and external entities while maintaining compliance and accuracy.

Qualifications

• 1 year of experience with provider disputes or claims.
• 1 year of interaction with claims with larger insurance plans.
• 1 year of general office or administrative experience.
• Experience directly relevant to the specific task order or project, preferred.

Responsabilités

• Coordinate delivery of re-determination files and dispute resolution documents between external entities.
• Build reconsideration/dispute resolution case files from evidence submitted and received.
• Analyze case type, appeal categories, and validity of requests per CMS or customer requirements.
• Input data for reconsiderations/dispute resolution into required systems.
• Respond to reconsideration/dispute review requests from appellants, patients, or providers.
• Route or respond to inquiries from appellants/patients regarding reconsiderations/dispute resolution processes.
• Identify suspected fraud or abuse and inform management.
• Stay updated on changes in regulations, policies and procedures.
• Submit requests for re-determination files and ALJ decisions to relevant entities.
• Participate in special projects and perform other duties as assigned.

Connaissances

Provider disputes

Claims interaction

Administrative tasks

Formation

High School Diploma or equivalent

Description du poste

Position: Dispute Resolution Analyst

Overview:
J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as a healthcare management consulting company. Our team of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels.

J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that need it most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow.

Position:
As a Dispute Resolution Analyst (DRA) you'll support the Independent Dispute Resolution (IDR) programs that handle routine 'Surprise Billing' appeals work. This role will serve as a support person for the reconsideration/dispute resolution professionals and physician reviewers for second level reconsiderations/dispute resolutions. Additionally, the DRA position will work under close supervision, with minimal latitude for the use of initiative and independent judgement

Role & Responsibilities:

• Coordinates the delivery of re-determination files/dispute resolution documents and reconsideration/dispute resolution decisions from and to the external entities.
• Builds a reconsideration/dispute resolution case file from evidence submitted and received and analyzes each case to ensure it meets the requirements for a valid reconsideration/dispute resolution request as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities.
• Analyzes and makes decisions based on medical vs. non-medical case type, appeal/review categories, validity of appeal/dispute resolution request, and dispute resolution settlement documentation.
• Inputs appropriate data regarding reconsiderations/dispute resolution cases into the applicable required systems.
• Responds to reconsideration/dispute review requests from appellants/patients/providers.
• Routes or responds to telephonic and/or written inquiries from appellants/patients about reconsiderations/dispute resolution or about the reconsiderations/dispute resolutions process from appellants/patient or their legally-designated representatives.
• Identifies any suspected instances of fraud and/or abuse and immediately inform management of such issues.
• Stays abreast of changes in regulations and practices, policies and procedures
• May submit requests for re-determination files and completed reconsideration and Administrative Law Judge (ALJ) decisions to relevant entities.
• Participates in special projects and performs other duties as assigned.

Experience / Expertise:

• One (1) years of experience with Provider disputes or claims
• One (1) years of interaction with claims with larger insurance plans
• One (1) year of general office or administrative experience
• Experience directly relevant to the specific task order or project, preferred

Education:

• High School Diploma or equivalent

Location: Remote
Salary: $16.25-18.25 per hour

J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.