What are the responsibilities and job description for the Specialist, Arbitration position at MPOWERHealth?
Overview
About MPOWERHealth:
For over a decade, MPOWERHealth has supported the independent musculoskeletal physician with best-in-class clinical services, back-office solutions, and advanced technology. We pride ourselves on being a partner that offers foresight to customers. We simplify what’s complex, and we help them find a better way. Our best-in-class analytics coupled with industry-leading expertise make MPOWERHealth the company our customers can rely on no matter what lies ahead.
Benefits:
- Multiple medical plan options
- Health Savings Account with company contributions
- Dental & vision coverage for you and your dependents
- 401k with Company match
- Vacation, sick time & Company paid holidays
- Company wellbeing program with health insurance incentives
Job Summary
The Arbitration Specialist is responsible for analyzing claims eligible for arbitration. This individual should possess superior communication and computer skills including familiarity, Microsoft Outlook, Word and Excel. This individual will review, analyze and report reimbursement integrity measures.
Responsibilities
Essential Job Duties and Responsibilities
- Analyze claim reports to determine claims eligible for Arbitration for both ERISA/NSA claims as well as state insurance department claims
- Prepare claims for submission to the appropriate portals for arbitration
- Have the ability for re-prioritizing key tasks and meet with manager and director to provide updates of findings and outcomes
- Work with external vendors such as State Department of Insurance (DOI) personnel and arbitrators to assist with issues and resolutions
- Complete special projects and other duties as assigned
- Strong computer skills including Microsoft Office with a strong proficiency in Excel spread sheets, using formulas, pivot tables, filters, etc.
- Strong organizational, analytical, and problem-solving skills
- Knowledge of the insurance industry
- Proven success in negotiation and technical writing
- Professionalism in all dealings, both internal and external
- Ability to clearly communicate, both verbally and in writing
- Knowledge of medical terminology
- Other duties as assigned
Qualifications
Education and/or Experience
- High School degree or equivalent
- Minimum of 3 years Medical Billing/Collections Management Experience
Skills/Specialized Knowledge
- Knowledge of CPT
- Knowledge of laws that regulates communication and privacy act. HIPAA laws and understanding of the application of all above
Other Requirements
- Must maintain professional appearance.
- Ability to be at work on a regular and consistent basis
Physical and Mental Demands
This position will spend long hours sitting and using office equipment and computers. The position may also entail light lifting of supplies and materials occasionally, up to and including 20 pounds in addition to reaching, stooping, standing, and walking. This position requires the ability to talk, hear, compare, compute, compile, copy, analyze, coordinate, synthesize, negotiate and communicate. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job functions.
Work Environment
Standard office working environment that may be busy and noisy at times.
