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

Healthcare Paralegal or NSA Open Negotiation Specialist

Position Summary

The NSA Claims and Open Negotiation Specialist will own the full lifecycle of out-of-network (OON) medical claim disputes subject to the federal No Surprises Act (NSA) and relevant state balance billing frameworks. The primary focus of this role is utilizing legal precision and medical billing data to initiate, track, and execute the mandatory 30-business-day Open Negotiation process via the CMS IDR Gateway.

The ideal candidate possesses a rare hybrid skill set: the analytical rigor and statutory deadline tracking of a medical paralegal paired with the coding and appeals expertise of an advanced revenue cycle biller. Your goal is to maximize fair provider reimbursement through data-driven negotiations, minimizing the need to upscale to costly Independent Dispute Resolution (IDR) arbitration.

Core Responsibilities

• Open Negotiation Lifecycle Management: Draft, compile, and submit formal Open Negotiation Notices. Aggressively monitor and review incoming Open Negotiation Response Notices from insurance payers.
• Claim Triage & Compliance Review: Audit underpaid or denied out-of-network remittance advice for specific claim adjustment reason codes to ensure payer compliance and determine true NSA eligibility. Understand when to reject a claim as NSA-ineligible.
• Evidence-Based Case Building: Gather supporting documentation (e.g., medical records, regional market data, patient acuity details, and provider training) to construct persuasive arguments countering the payer's Qualifying Payment Amount (QPA). Experience drafting appeals, briefs, or supporting letters is mandatory.
• Arbitration (IDR) Execution: When open negotiations fail, execute the timely initiation of the IDR process via the CMS portal within the strict 4-business-day statutory window.
• Flawless Deadline Tracking: Maintain an airtight legal calendar to enforce strict tracking of the 30-business-day negotiation, 4-day IDR filing window, and subsequent cooling-off periods to protect the practice from missing critical filing dates.

Required Qualifications

• Education & Credentials: Paralegal Certificate, or Bachelor's Degree in Legal Studies, Healthcare Administration, or a related field. Professional coding or billing certifications (e.g., CPC, CPB, CMB) are highly preferred.
• Experience: Minimum of 2–4 years of direct experience handling out-of-network (OON) medical billing, revenue cycle appeals, claims disputes, or medical appeals.
• NSA Expertise: Experience managing disputes from open negotiation through final offer selection.
• Regulatory Knowledge: Deep understanding of the federal No Surprises Act, IDR entity determining factors, and relevant state-level arbitration guidelines.
• Technical Skills: Advanced capabilities in Microsoft Excel for compiling claim data and managing high-volume dispute tracking.