$57532.29–$79106.9 yearly
Full-time
Melville
The RCM Insurance Arbitration Support Paralegal will join our dedicated out-of-network team, focusing on fully supporting the arbitration process for state and federal cases while maximizing reimbursements from out-of-network payers. This critical role involves managing arbitration processes when major payers are pushed out of network and supporting the team in handling all out-of-network claims to ensure appropriate claim processing by the insurance companies. Key responsibilities include preparing and overseeing arbitration cases, negotiating non-arbitrated disputes to secure maximum payments, and providing essential support to the Managed Care team during payer negotiations. The ideal candidate will possess strong organizational and legal research skills, along with a deep understanding of insurance claims and healthcare reimbursement. RESPONSIBILITIES
Arbitration Support: Assist in preparing and managing the arbitration process for out-of-network claims, including gathering necessary documentation, drafting legal correspondence, and coordinating with external legal counsel as needed. Ensure compliance with state and federal arbitration regulations.
Dispute Resolution: Handle other out-of-network disputes that do not result in arbitration by negotiating with payers to process claims at maximum reimbursements. Collaborate with the out-of-network team to prepare and submit appeal letters and follow up on denied or underpaid claims to ensure optimal financial outcomes. Provide guidance on tactics for maneuvering the landscape for major markets.
Managed Care Support: Collaborate with the Managed Care team to provide guidance on applicable state and federal guidelines for arbitration when major payers move to out-of-network status.
Documentation and Compliance: Maintain accurate and up-to-date records of all arbitration and dispute cases. Ensure that all activities are following relevant laws, regulations, and organizational policies.
Legal Research: Conduct legal research on state and federal arbitration laws and regulations to support case preparation and strategy. Stay updated on changes in healthcare and insurance laws that may impact arbitration and dispute processes. REQUIRED QUALIFICATIONS
Bachelor's Degree preferred and Paralegal Certificate required.
Minimum of three years of related experience with Litigation Healthcare Insurance law, No Surprise Act claims and arbitrations.
Strong skills in data mining and is a detail researcher with fact-checking.
Ability to recognize and analyze complex contracting issues and discuss such issues with in-house attorneys and internal departments.
Excellent written and verbal communication skills.
High level of professionalism, dependability, and strong interpersonal skills.
Ability to work independently and efficiently in a fast-paced, deadline-driven business environment, with a high focus on accuracy.
High level of proficiency with Apttus, MS Office products, including Word, Excel, and SharePoint.
