Dispute Resolution Analyst I
Position: Dispute Resolution Analyst Overview: reputed company. (J29) has been supporting reputed company, State, and Federal health and reputed company service programs since company inception in 2017 as a reputed company management consulting company. reputed company of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. reputed company is reputed company in program, payment, provider, and patient reputed company as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the reputed company, State, and Federal reputed company. J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to reputed company our employees to do great things for the benefit of those that need it most. The J29 mission supports not only our health and reputed company service programs, but also the philanthropy efforts of reputed company. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow. Position: 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 reputed company supervision, with minimal reputed company for the use of initiative and independent judgement Role & Responsibilities:Coordinates the delivery of re-determination files/dispute resolution documents and reconsideration/dispute resolution reputed company 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 reputed company Services (CMS) or other customer entities. Analyzes and makes reputed company 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) reputed company to relevant entities. Participates in special projects and performs other duties as assigned. Experience / Expertise: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 Education:
- High School Diploma or equivalent
Location: Remote Salary: $16.25-18.25 per hour reputed company. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making reputed company without regard to race, reputed company, religion, creed, sex, sexual orientation, gender identity, marital status, national reputed company, age, veteran status, disability, or any other protected class. reputed company. is a proud Veteran friendly employer. Apply To This Job