183 Best Other Jobs in Pittsford, NY (December 2024)

Overview: We are seeking a detail-oriented and knowledgeable individual to join our team as a Federal No Surprise Act Arbitrator, in this role you will be responsible for handling disputes in the Independent Dispute Resolution process between healthcare providers and insurance companies. This role requires a deep understanding of the No Surprises Act, knowledge about healthcare services, claims adjudication, and strong critical/analytical thinking and writing skills. Key Responsibilities: Render payment determinations on disputes between providers and health plans as outlined by the No Surprises Act. Review submissions from both parties and ensure all documentation is complete and accurate. Conduct thorough analysis of the dispute, considering the qualifying payment amount (QPA), other factors relating to factors as identified in regulations and guidance, and other relevant additional documentation submitted by the parties. Render final and binding payment determinations decisions in a timely and impartial manner based on the documentation provided relating to the QPA and decision-making factors. Interpret laws and procedure to settle disputes. Responsible for requesting additional information from parties where necessary. Handles disputes and ensures all steps are completed to finalize disputes. Utilize case processing systems to document all steps in the process and the findings. Researches and resolves dispute questions or concerns. Maintain up-to-date knowledge of the No Surprises Act and related regulations. Experience and Skills: Experience in healthcare law, arbitration, mediation, dispute resolution or claims adjudication in healthcare. Strong analytical and critical thinking skills. Excellent written and verbal communication abilities. Ability to handle sensitive information with integrity and confidentiality. Healthcare Coding experience preferred. Familiarity with healthcare finance and insurance practices. Experience working with federal healthcare regulations. Attention to detail. Proficiency in operating across various platforms and displays. Ability to work efficiently and independently. Able to follow processes and procedures, understanding of rules and regulations.

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