Claims Dispute Specialist

Job Description

The Advanced Reconstructive Surgery Alliance (ARSA) and its affiliates are the largest Reconstructive Plastic Surgery medical practice in the country. Our expanding team of top tier physicians, coupled with our continued medical advancements, allows us to offer patients extraordinary clinical services with 5-star experience. We have a bold vision with a desire to revolutionize the industry; meeting patient needs while favorably transforming their lives. Common across the enterprise is not only the commitment to providing superior patient care, but to employee satisfaction and growth opportunities. It is a culture of teamwork, respect and appreciation for all employees—whether caring for patients directly or working in a support role.

We are seeking a Claims Dispute Specialist.

The Claims Dispute Coordinator manages and resolves complex medical claim disputes and appeals with a focus on compliance with the Federal No Surprises Act (NSA) and similar state surprise billing laws. This role requires strong written communication skills, analytical skills and attention to detail. The ideal candidate brings the ability to efficiently prepare strong written arguments based on complex medical claims while effectively managing dispute process deadlines.

Key Responsibilities

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• Review and analyze medical claims to ensure accuracy, compliance, and eligibility for appeal or dispute under the NSA or state law
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• Investigate claim payments and denials by reviewing clinical documentation, insurance payer contracts, and claim history
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• Initiate and manage disputes under the NSA or state law
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• Prepare clear and effective written arguments as part of claims dispute processes
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• Analyze data and identify insights to support negotiations and dispute arguments
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• Collaborate with various teams within ARSA to ensure timely and successful dispute resolution
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Qualifications and Experience

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• 1–3 years in healthcare claims processing preferred
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• Experience with No Surprises Act dispute resolution highly preferred
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• Bachelor’s degree relevant field preferred
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Skills

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• Strong analytical and problem-solving abilities
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• Strong written and verbal communication skills
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• Strong organization skills
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• Ability to manage multiple priorities and meet deadlines in a fast-paced environment
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• Proficiency in Microsoft Office suite and healthcare practice management systems
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Compensation & Benefits:

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• · Pay Range: $55,000- $60,000annually
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• the starting rate within this range for this role varies depending on a number of factors, including a candidate’s qualifications, skills, competencies, experience, and location.
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• · Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance
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• · 401k and Profit sharing
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• · Paid Time Off
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• · Contribution to Health Benefits
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• Company Discounts on Products & Services
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