Dispute Resolution Analyst

General Description:

J29 is a healthcare management company with significant experience providing clinical, policy, and administrative review and analysis of some of the nations most complex healthcare programs. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates. Our team brings corporate performance that stretches to various areas of the Department of Health and Human Services, such as the Centers for Medicare and Medicaid Services (CMS), and Health Resources and Services Administration.

As a Dispute Resolution Analyst (DRA) you’ll support the Independent Dispute Resolution (IDR) programs that handle routine 'Surprise Billing' appeals work. This role will serve as a support person for the reconsideration/dispute resolution professionals and physician reviewers for second level reconsiderations/dispute resolutions. Additionally, the DRA position will work under close supervision, with minimal latitude for the use of initiative and independent judgement.

Essential Responsibilities:

Coordinates the delivery of re-determination files/dispute resolution documents and reconsideration/dispute resolution decisions from and to the external entities.

Builds a reconsideration/dispute resolution case file from evidence submitted and received and analyzes each case to ensure it meets the requirements for a valid reconsideration/dispute resolution request as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities.

Analyzes and makes decisions based on medical vs. non-medical case type, appeal/review categories, validity of appeal/dispute resolution request, and dispute resolution settlement documentation.

Inputs appropriate data regarding reconsiderations/dispute resolution cases into the applicable required systems.

Responds to reconsideration/dispute review requests from appellants/patients/providers.

Routes or responds to telephonic and/or written inquiries from appellants/patients about reconsiderations/dispute resolution or about the reconsiderations/dispute resolutions process from appellants/patient or their legally-designated representatives.

Identifies any suspected instances of fraud and/or abuse and immediately inform management of such issues.

Stays abreast of changes in regulations and practices, policies and procedures.

May submit requests for re-determination files and completed reconsideration and Administrative Law Judge (ALJ) decisions to relevant entities.

Participates in special projects and performs other duties as assigned.

Minimum Qualifications

Education

High School Diploma or equivalent

Experience

One (1) years of experience with Provider disputes or claims

One (1) years of interaction with claims with larger insurance plans

One (1) year of general office or administrative experience

Experience directly relevant to the specific task order or project, preferred

Knowledge, Skills and Abilities

Some Knowledge of

Research techniques

Medicare appeals program

Applicable systems and applications

Applicable laws, rules and regulations

Some Skill in

Preparing correspondence/documents using correct spelling, grammar and punctuation; proofreading and reviewing documents for clarity and consistency

Prioritizing and organizing work assignments

Researching, analyzing and interpreting policies and state and federal laws and regulations

The use of personal computers and applicable programs, applications and systems

Ability to

Meet production and quality standards

Multitask and meet deadlines

Exercise logic and reasoning to define problems, establish facts and draw valid conclusions

Make decisions that support business objectives and goals

Identify and resolve problems or refer issues appropriately

Communicate effectively verbally and in writing

Adapt to the needs of internal and external customers

Show integrity and ethical behavior; respect confidentiality, business ethics and organizational standards

Assure compliance with regulatory, contractual and accreditation entries

Type of Work

Hourly/Non-Exempt

Temporary (4-6 months) with chance of permanent placement

Location:

Remote: US Based

CMS regulation require US Residence 3 of the past 5 years.

Why J29?

J29 is an employee centric Federal Contractor that focuses on creating health and IT solutions for the better of the community. Making company culture the main priority ensures employees satisfaction and retention. We believe in empowering employees to do great things. When you invest in your people, and focus on creating a healthy work life balance, then your employees will take care of your customers and make sure they are happy. One of our sayings is “Work Hard and Be Nice to People” – it really is that simple.

J29 Solutions

Check J29 Inc. out on LinkedIn!

EEO Statement

J29, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.