Dispute Resolution Lead

Company: MultiPlan
Location: Atlanta
Posted on: May 28, 2023

Job Description:

JOB SUMMARY: In addition to managing a substantial arbitration case load, this role works with the leadership team to assure that the arbitration team meets its performance metrics, quality performance, and business objectives. This role manages an arbitration case load including evaluation of provider disputes and appropriate client payment offers. The incumbent will coordinate efforts with the team and leadership to bring matters to efficient and successful outcomes. JOB ROLES AND RESPONSIBILITIES: 1. Perform weekly Soft Audits on cases work by team members and address performance issues.
2. Identify, design and execute training needs on an individual basis. Discuss training needs for the team with manager and provide continuous coaching of the staff so they perform at the highest levels.
3. Perform additional administrative tasks such as monitoring team chat's or emails for questions, participate in team meetings for response to team questions or help identify issues.
4. Host weekly or bi-weekly Team Huddles for case discussion and review.
5. Prepare written analyses of disputed provider/health plan positions and persuasively document arguments supporting client positions in arbitration packages pursuant to federal regulations.
6. Conduct due diligence (e.g. online research, portal and application research) to assist with the analysis and preparation of arbitration packages.
7. Works with other departments to develop or obtain information necessary for the submission of IDR packages.
8. Review and analyze clinical information along with documents submitted by providers of moderate to high complexity.
9. Meet federal filing deadlines and turn around times
10. Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; maintain detailed and accurate records.
11. Outreach to clients for data needed for arbitration packages
12. Maintain department productivity and quality standards
13. Sensitivity to privacy in accordance with HIPAA guidelines
14. Collaborate, coordinate, and communicate across disciplines and departments.
15. Ensure compliance with HIPAA regulations and requirements.
16. Demonstrate Company's Core Competencies and values held within.
17. 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. JOB SCOPE:
Keep the needs of external and internal customers as a priority when making decisions and taking action. Operates independently under limited supervison. Has decision making authority within specified parameters and must engage advice and/or help of manager to proactively resolve cases. Works across customers, beneficiaries, providers, and suplimental payors while maintaining positive relationships. The incumbent must be open to feedback, teamwork and show interest in contributing ideas to improve organizational processes. Guides the others on the team, provides coaching, provides and prioritizes work load across the team.

Keywords: MultiPlan, Atlanta , Dispute Resolution Lead, Other , Atlanta, Georgia