Dispute Resolution Lead
Company: MultiPlan
Location: Atlanta
Posted on: May 28, 2023
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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
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