Jurisdictional Analyst

Commence; Maryland; On-site; USD 70,000 - 90,000; Full time

Job summary

Commence in Maryland seeks a Jurisdictional Analyst to translate complex healthcare rules into clear jurisdictional determinations and IDR-related documentation. You will determine whether state or federal jurisdiction applies and draft determinations for reviewers and medical coders.

In this role, you will prioritize multiple cases, maintain strict confidentiality under HIPAA/HITECH, and collaborate with attorneys and staff to ensure accurate, timely decisions.

Qualifications

• Associates degree with a major in paralegal studies or a bachelor’s degree in legal services or business administration with a major in paralegal studies and/or a Paralegal certification.
• Exhibit excellent attention to detail, strong proofreading and organizational skills, and excellent oral and written communication with internal parties.
• Must simultaneously manage several projects, task functions, and complex contractual requirements.
• Proficient in Microsoft Office, including Word and Excel.
• Highly attentive to detail and excellent organizational and time management skills
• Clear, concise, and logical writing style.
• Display the qualities of an efficient multi-tasker who can manage competing demands with differing deadlines and work well with attorneys, professionals, and other staff.

Responsibilities

• Determine jurisdictional decisions and write appropriate jurisdiction determinations, especially when federal jurisdiction is applicable.
• Review medical records to assist in final IDR determinations.
• Screen for conflicts of interest and verify compliance with review timelines and regulatory prerequisites.
• Understand, in general, how healthcare insurance functions and the laws governing IDR processes.
• Protect patient confidentiality and ensure HIPAA/HITECH compliance in all work.

Skills

Attention to detail

Communication

Multitasking

Time management

Legal writing

Paralegal knowledge

Education

Associate degree in paralegal studies

Bachelor's degree in legal services or business administration with a major in paralegal studies

Paralegal certification

Tools

Microsoft Word

Microsoft Excel

Microsoft Office

Job description

Job Type

Full-time

Description

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

Requirements

We are seeking a Jurisdictional Analyst to ignite a new era of impactful health outcomes with data that drives answers, technology that advances performance, and expertise that builds trust.

• Determine whether a corporate conflict of interest prevents Commence from reviewing the dispute.
• Screen out cases covered by a prior decision involving the same parties within the designated time limit, i.e., the 90-day cooling off period.
• Determine whether other regulatory timeframes that are a prerequisite for jurisdiction have been met.
• Determine whether the case jurisdiction is state or federal.
• Write appropriate jurisdictional determinations. In cases in which federal jurisdiction is appropriate, include any other information noted that would be useful to the medical coders, nurses, and legal arbitrators in determining the resolution of the disputed claim in the determination.
• Demonstrate experience in prioritizing work and determining when to bring issues, concerns, or discrepancies to the supervisor's attention.
• Review medical records to assist in the final IDR determination.
• Understand, in general, how healthcare insurance functions.
• Understand state and federal medical and jurisdictional laws applicable to the IDR process.
• Exercise discretion to address potential issues before they become problems.
• Protect the confidentiality of patient information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH).

Qualifications

• Associates degree with a major in paralegal studies or a bachelor’s degree in legal services or business administration with a major in paralegal studies and/or a Paralegal certification. Relevant experience can be substituted for formal training requirements.
• Exhibit excellent attention to detail, strong proofreading and organizational skills, and excellent oral and written communication with internal parties.
• Must simultaneously manage several projects, task functions, and complex contractual requirements.
• Proficient in Microsoft Office, including Word and Excel.
• Highly attentive to detail and excellent organizational and time management skills
• Clear, concise, and logical writing style.
• Display the qualities of an efficient multi-tasker who can manage competing demands with differing deadlines and work well with attorneys, professionals, and other staff.

Preferred Qualifications

• Display knowledge of how insurance claims are processed, including an understanding of medical coding and claim rejections that assist in determining a case that is part of the IDR process.
• Medical coding certification is preferred.

Commence is an equal employment opportunity employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at [phone] or [e-mail].

Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.