Arbitration Specialist
7 days ago
As an Arbitration Specialist, you will be responsible for reviewing, analyzing, and preparing claims eligible for arbitration in both ERISA/NSA and state insurance department claims. You'll collaborate with external vendors and arbitrators, ensuring accuracy and compliance while leveraging your expertise in medical collections.
Key Responsibilities:
- Analyze claim reports to determine eligibility for arbitration (ERISA/NSA and state insurance claims).
- Prepare and submit claims for arbitration through appropriate portals.
- Reprioritize key tasks as needed and provide regular updates to the manager and director.
- Collaborate with external vendors, including state insurance departments and arbitrators, for issue resolution.
- Compile medical records and explanations of benefits into a formal document for arbitration submissions.
- Meet KPI goals of processing 15-20 submissions per day.
- Utilize Microsoft Excel for data analysis, including formulas, pivot tables, and filters.
- Demonstrate proficiency in negotiation and technical writing.
- Maintain professionalism in all communications, both internal and external.
- Ensure compliance with medical terminology standards and industry regulations.
Qualifications:
- Education: High school diploma or equivalent.
- Experience: Minimum of 3 years in Medical Billing/Collections Management.
- Skills & Knowledge: Proficiency in CPT codes and HIPAA regulations.
- Strong knowledge of laws governing communication and privacy.
- Excellent organizational, analytical, and problem-solving abilities.
- Strong communication skills, both verbal and written.
- Ability to maintain professionalism and adhere to attendance expectations.
Job Types: Full-time, Permanent
Application Question(s):
- Willing to work onsite nightshift?
- Do you have background in healthcare?
Work Location: In person
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