Paralegal

Healthcare Paralegal or NSA Open Negotiation Specialist Position Summary The NSA Claims and Open Negotiation Specialist will own the full lifecycle of out-of-network (OON) medical claim disputes subject to the federal No Surprises Act (NSA) and relevant state balance billing frameworks. The primary focus of this role is utilizing legal precision and medical billing data to initiate, track, and execute the mandatory 30-business-day Open Negotiation process via the CMS IDR Gateway. The ideal candidate possesses a rare hybrid skill set: the analytical rigor and statutory deadline tracking of a medical paralegal paired with the coding and appeals expertise of an advanced revenue cycle biller. Your goal is to maximize fair provider reimbursement through data-driven negotiations, minimizing the need to upscale to costly Independent Dispute Resolution (IDR) arbitration. Core Responsibilities Open Negotiation Lifecycle Management: Draft, compile, and submit formal Open Negotiation Notices. Aggressively monitor and review incoming Open Negotiation Response Notices from insurance payers. Claim Triage & Compliance Review: Audit underpaid or denied out-of-network remittance advice for specific claim adjustment reason codes to ensure payer compliance and determine true NSA eligibility. Understand when to reject a claim as NSA-ineligible. Evidence-Based Case Building: Gather supporting documentation (e.g., medical records, regional market data, patient acuity details, and provider training) to construct persuasive arguments countering the payer's Qualifying Payment Amount (QPA). Experience drafting appeals, briefs, or supporting letters is mandatory. Arbitration (IDR) Execution: When open negotiations fail, execute the timely initiation of the IDR process via the CMS portal within the strict 4-business-day statutory window. Flawless Deadline Tracking: Maintain an airtight legal calendar to enforce strict tracking of the 30-business-day negotiation, 4-day IDR filing window, and subsequent cooling-off periods to protect the practice from missing critical filing dates. Required Qualifications Education & Credentials: Paralegal Certificate, or Bachelor's Degree in Legal Studies, Healthcare Administration, or a related field. Professional coding or billing certifications (e.g., CPC, CPB, CMB) are highly preferred. Experience: Minimum of 2–4 years of direct experience handling out-of-network (OON) medical billing, revenue cycle appeals, claims disputes, or medical appeals. NSA Expertise: Experience managing disputes from open negotiation through final offer selection. Regulatory Knowledge: Deep understanding of the federal No Surprises Act, IDR entity determining factors, and relevant state-level arbitration guidelines. Technical Skills: Advanced capabilities in Microsoft Excel for compiling claim data and managing high-volume dispute tracking. #J-18808-Ljbffr