Dispute Resolution Specialist

Imagine360; United States; A distancia; USD 55.000 - 75.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Multiple Health plan options

Company paid employee premiums for dis

Parental Leave Policy

20 days PTO to start

10 Paid Holidays

Tuition reimbursement

401k Company contribution

Short & Long term Disability plus Life

Professional development initiatives

Diversity & inclusion initiatives

Descripción de la vacante

Imagine360, LLC is seeking a Dispute Resolution Specialist to join the team. The role focuses on research, strategy, communication, and Independent Dispute Resolution (IDR), coordinating with leadership to achieve efficient outcomes.

The position oversees intake, processing and coordination of materials as regulated by federal or state law. Position is 100% remote with duties including analysis of disputed health plan positions, due diligence for arbitration packages, and collaboration across

Formación

• Minimum 1 year of experience in healthcare operations relating to the No Surprises Act or Independent Dispute Resolution.
• Proven ability to manage multiple priorities and meet deadlines.
• Strong organizational and analytical abilities.
• Ability to learn quickly and work independently.
• Proficient in MS Word, Excel and Outlook.

Responsabilidades

• Prepare written analyses of disputed health plan positions and persuasively document arguments supporting client positions in arbitration packages pursuant to federal regulations.
• Conduct due diligence to assist with the analysis and preparation of arbitration packages.
• Work 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.
• Maintain detailed and accurate records.
• Maintain department productivity and quality standards.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Any other duties or responsibilities related to IDR that may be otherwise required or assigned as necessary.

Conocimientos

Organizational skills

Analytical skills

Independent decision-making

Problem solving

Time management

Microsoft Word

Microsoft Excel

Outlook

Written and verbal communication

Descripción del empleo

Imagine360 is seeking a Dispute Resolution Specialist to join the team! The Dispute Resolution Specialist will be the primary party responsible for research, strategy, communication, and all other matters related to Independent Dispute Resolution ("IDR"). The incumbent will coordinate efforts with the team and leadership to bring matters to efficient and successful outcomes. The Dispute Resolution Specialist will oversee the intake, processing and coordination of all materials and information as regulated by Federal or state law.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Prepare written analyses of disputed health plan positions and persuasively document arguments supporting client positions in arbitration packages pursuant to federal regulations.
• Conduct due diligence to assist with the analysis and preparation of arbitration packages.
• Work 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.
• Maintain detailed and accurate records.
• Maintain department productivity and quality standards.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Any other duties or responsibilities related to IDR that may be otherwise required or assigned as necessary.

Required Experience/Education:

• Minimum 1 year of experience in healthcare operations relating to the No Surprises Act or Independent Dispute Resolution.

Skills and Abilities:

• 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.

What can Imagine360 offer you?

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.