Healthcare NSA Claims Negotiation Paralegal

Pond Lehocky Giordano Inc.; Haddonfield (NJ); On-site; USD 70,000 - 110,000; Full time

Job summary

Pond Lehocky Giordano Inc. in New Jersey seeks a Healthcare Paralegal or NSA Open Negotiation Specialist to manage the full lifecycle of OON medical claim disputes under NSA and state balance billing rules.

You will drive the Open Negotiation process, review filings, assemble evidence, and coordinate with IDR when needed to protect client interests. The role requires regulatory knowledge, experience with NSA disputes, and strong Excel skills to track complex data.

Qualifications

• Paralegal Certificate or Bachelor's Degree in Legal Studies, Healthcare Administration, or related field.
• Professional coding or billing certifications (e.g., CPC, CPB, CMB) are highly preferred.
• 2–4 years of direct experience handling out-of-network medical billing, revenue cycle appeals, claims disputes, or medical appeals.
• Experience managing disputes from open negotiation through final offer selection (NSA).
• Deep understanding of NSA, IDR factors, and state arbitration guidelines.

Responsibilities

• Open Negotiation Lifecycle Management: Draft, compile, and submit Open Negotiation Notices and monitor responses.
• Claim Triage & Compliance Review: Audit remittance advice to ensure NSA eligibility and identify NSA-ineligible claims.
• Evidence-Based Case Building: Gather medical records, market data, and provider details to counter the payer’s QPA.
• Arbitration (IDR) Execution: Initiate IDR timely via CMS portal within a 4-business-day window when negotiations fail.
• Flawless Deadline Tracking: Maintain calendar for 30-day negotiation, 4-day IDR filing, and cooling-off periods.

Skills

NSA Expertise

Regulatory Knowledge

Open Negotiation Lifecycle Management

Evidence-Based Case Building

Deadline Tracking

Education

Paralegal Certificate

Bachelor's Degree in Legal Studies

Bachelor's Degree in Healthcare Administration

Tools

Microsoft Excel

Job description

Pond Lehocky Giordano Inc. in New Jersey seeks a Healthcare Paralegal or NSA Open Negotiation Specialist to manage the full lifecycle of OON medical claim disputes under NSA and state balance billing rules.

You will drive the Open Negotiation process, review filings, assemble evidence, and coordinate with IDR when needed to protect client interests. The role requires regulatory knowledge, experience with NSA disputes, and strong Excel skills to track complex data.