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Claritev · 2 days ago

Dispute Resolution Specialist II

United States

Full-time

Remote

Mid Level

$19/hr - $21/hr

4+ years exp

Claritev is a dynamic team of innovative professionals striving to bend the cost curve in healthcare. The Dispute Resolution Specialist II will manage an arbitration case load, evaluate provider disputes, and coordinate the resolution of complex escalated issues while ensuring compliance with applicable regulations.

BillingHealth CarePayments

Responsibilities

Assume primary responsibility for determining appropriate amount of client plan arbitration offers

Draft briefs and offers persuasively documented arguments supporting client positions in arbitration packages pursuant to federal regulations

Conduct due diligence (e.g. online research, portal and application research) to assist with the analysis and preparation of arbitration packages

Works 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

Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; maintain detailed and accurate records

Outreach to clients for data needed for arbitration packages

Maintain department productivity and quality standards

Sensitivity to privacy in accordance with HIPAA guidelines

Collaborate, coordinate, and communicate across disciplines and departments

Ensure compliance with HIPAA regulations and requirements

Demonstrate Company's Core Competencies and values held within

The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary

Qualification

Healthcare operationsAnalytical skillsProblem solvingMicrosoft WordMicrosoft ExcelMicrosoft OutlookWritten communicationVerbal communicationOrganizational skillsDecision making

Required

Minimum high school diploma or equivalent (GED) and four (4) years' experience in healthcare operations

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

Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

Preferred

Bachelors' degree in a related field

Benefits

Medical, dental and vision coverage with low deductible & copay

Life insurance

Short and long-term disability

Paid Parental Leave

401(k) + match

Employee Stock Purchase Plan

Generous Paid Time Off - accrued based on years of service

10 paid company holidays

Tuition reimbursement

Flexible Spending Account

Employee Assistance Program

Sick time benefits - for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits

Company

Claritev

Glassdoor3.8

Claritev is an independent and public healthcare technology, data and insights company making healthcare more transparent, fair and affordable for all.

Founded in 1980

Mclean, Virginia, USA

1001-5000 employees