Health Care Arbitrator

JOB SUMMARY

The Arbitrator makes the payment determination in the independent dispute resolution process between providers, facilities or providers of air ambulance services, out of network services and excessive emergency room charges provided by group health plans, health insurance issuers and Federal Employees Health Benefits (FEHB) Program carriers. The arbitrator makes the determinations based on the rules enacted under the No Surprises Act (NSA). The NSA process requires that the Entity determine the eligibility of a case and whether any conflict of interest exists for the arbitrator selected for a particular dispute. The responsibilities of an arbitrator include analyzing information provided by the Parties to the dispute using knowledge of the NSA requirements, acceptable criteria under the NSA, and creating a report on the outcome of the arbitration process according to the NSA requirements. There is no hearing component for these reviews; this is strictly a paper review process.

To be successful as an Arbitrator, you should have solid knowledge of healthcare related payment determinations, sound organizational skills, and strong understanding of industry practices. Ultimately, a top-notch arbitrator must have the ability to remain neutral when analyzing the materials provided by the parties to the dispute and be able to write a concise decision in a short period of time. Prior administrative law experience, dispute resolution or hearing officer experience are helpful. Preference will be given to arbitrators with specific training and healthcare/insurance review experience.

Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other, and Dane Street. It is the responsibility of all of us to maintain a positive working environment that promotes client satisfaction and results.

MAJOR DUTIES & RESPONSIBILITIES

• Reviewing materials related to the dispute and review of any potential data related to the issues in question.
• Provide a written decision based on baseball arbitration processes.
• Applying laws, procedures, and industry knowledge to settle disputes.
• Obtain Dane Street training for the program and complete review process review.
• Submit reporting on Dane Street’s portal and submit billing on the completed review.
• Other duties & special projects, as assigned and based on business needs.

Requirements

EDUCATION/CREDENTIALS:

Law, business degree or extensive coding experience is required.

Solid knowledge of procedures, policies, and law.

Demonstrate a neutral disposition.

Strong communication skills.

Good writing skills

JOB RELEVANT EXPERIENCE:

Business experience in a healthcare and/or insurance setting is preferred.

JOB RELATED SKILLS/COMPETENCIES:

Present exceptional communication skills with a clear understanding of company business lines. The ability to apply critical thinking, manage time efficiently and meet specific deadlines. Computer literacy and typing skills are essential.

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services.

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

This job description is subject to change at any time.