Sr Admin - Arbitration
Essential Duties and Responsibilities:
- Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position
- Function as a Subject Matter Expert in one or more process areas.
- Analyze data submitted for Independent Medical Review.
- Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.
- Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.
- Create arbitration cases in the system.
- Send requests for information to providers and health plans.
- Close arbitration cases in the system.
- Analyze data received from providers and health plans.
Minimum Requirements
- Associate degree with 2+ years' experience.
- Experience in lieu of an Associate degree (HS Diploma or GED and 4+ years of experience) also considered.
- Ability to manage multiple tasks efficiently and maintain accurate records.
- Excellent written and verbal communication skills to interact with healthcare providers and insurance companies.
- Ability to work across multiple platforms.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and healthcare billing systems.
- Ability to successfully work in a fast-paced, deadline-driven environment.
- High level of accuracy in data entry and document management.
- Ability to work independently as a part of a team remotely.
- Experience with Salesforce platform preferred.
- U nderstanding of healthcare billing, CPT codes, and the No Surprises Act preferred.
- Experience with healthcare appeals and/or grievances preferred.
- Experience with retroactive claim review highly preferred.
- Familiarity with insurance documentation, explanation of benefits, and/or claim forms highly preferred.
- Ability to commit to a schedule of 8:00am - 5:00pm EST Monday - Friday required. Please note: For this position Maximus will provide equipment to use. Home Office Requirements:
- Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at [email protected] . Minimum Salary $18.75 Maximum Salary $20.00 Apply tot his job Apply To this Job