Job Description
Who We Are
We are a fast-growing arbitration/medical billing company looking for a positive person who is interested in being a success and will help take the company to the next level. The professional for this job needs superior communication and computer skills including familiarity with Microsoft Outlook, Excel and Word. This individual evaluates medical-legal disputes between healthcare providers and insurance companies and performs a wide variety of tasks such as generating reports. We are seeking highly detail-oriented medical professionals to review healthcare dispute case files, apply structured review criteria and guidelines to reach well documented, defensible decisions on each case.
Job Summary
The Arbitration Specialist, Enhanced Resolution Services is responsible for analyzing claims eligible for arbitration. This individual should possess superior communication and computer skills including Microsoft Outlook, Excel and Word. This individual will review, analyze and report reimbursement of integrity measures.
Essential Job Duties and Responsibilities
- Analyze claim reports to determine claims eligible for Arbitration for both ERISA/NSA claims as well as state insurance department claims
- Prepare claims for submission to the appropriate portals for arbitration
- Ability to re-prioritize key tasks and meet with team lead and manager to provide updates of findings and outcomes
- Complete special projects and other duties as assigned
- Strong computer skills including Microsoft Office with a strong proficiency in Excel spread sheets, using formulas, pivot tables, filters, etc.
- Strong organizational, analytical, and problem-solving skills
- Knowledge of the insurance industry
- Professionalism in all dealings, both internal and external
- Ability to clearly communicate, both verbally and in writing
- Knowledge of medical terminology
- Other duties as assigned
Education and/or Experience
- High School Diploma or equivalent is required
- 1+ years of experience analyzing claim reports to determine claims eligibility for Arbitration for both ERISA/NSA claims as well as state insurance department claims
- 1+ years of Healthcare experience, or experience with healthcare related claims, disputes, or regulatory matters
- Familiarity with independent dispute resolution, or other arbitration frameworks
- Experience working with case management systems or similar tracking tools
Skills/Specialized Knowledge
- Knowledge of CPT is (highly preferred)
- Experience in CMS Complaint reviewing and filing (highly preferred)
- Knowledge of IDR/NSA Procedures (highly preferred)
- Knowledge of laws that regulate communication and privacy act
- Understanding of HIPAA Laws
Other Requirements
- Must maintain professional appearance
- Ability to be at work on a regular and consistent basis
- Proficiency in using the computer as your primary tool for performing these job responsibilities is required
Work Environment
- Remote work environment, ability to work independently and in a group setting
Perks & Benefits
- Fully Remote - Work from anywhere within the United States with reliable high-speed internet
- Multiple medical plan options
- Health Savings Account with company contributions
- Dental & vision coverage for you and your dependents
- 401k with Company match
- Vacation, sick time & Company paid holidays
- Company wellbeing program with health insurance incentives
What's Next?
If you're ready to bring your skills and passion to our growing team, we want to hear from you! Apply today and help us create a future where success is the standard.
It is the policy of HaloMD not to discriminate against any applicant for employment, or any employee because of age, color, sex, disability, national origin, race, religion, or veteran status.
This employer participates in E-Verify to confirm the identity and employment
eligibility of all new hires. Form I-9 information will be submitted to
E-Verify for verification. If E-Verify cannot confirm your eligibility,
you will be given written instructions and an opportunity to contact DHS
or SSA to resolve the issue before any action is taken.