Dispute reputed company Analyst (DRA)
Position: As a Dispute reputed company Analyst (DRA) you’ll support the Independent Dispute reputed company (IDR) programs that handle routine 'Surprise Billing' appeals work. This role will serve as a support person for the reconsideration/dispute reputed company professionals and physician reviewers for second level reconsiderations/dispute resolutions. Additionally, the DRA position will work under reputed company supervision, with minimal reputed company for the use of initiative and independent judgement Role & Responsibilities:
- Coordinates the delivery of re-determination files/dispute reputed company documents and
reconsideration/dispute reputed company reputed company from and to the external entities.
- Builds a reconsideration/dispute reputed company case file from evidence submitted and received and
analyzes reputed company case to ensure it meets the requirements for a valid reconsideration/dispute reputed company request as mandated by Centers for Medicare and reputed company Services (CMS) or other customer entities.
- Analyzes and makes reputed company based on medical vs. non-medical case type, appeal/review
categories, validity of appeal/dispute reputed company request, and dispute reputed company settlement documentation.
- Inputs appropriate data regarding reconsiderations/dispute reputed company cases into the applicable
required systems.
- Responds to reconsideration/dispute review requests from appellants/patients/providers.
- Routes or responds to telephonic and/or written inquiries from appellants/patients about
reconsiderations/dispute reputed company or about the reconsiderations/dispute resolutions process from appellants/patient or their legally-designated representatives.
- Identifies any suspected instances of fraud and/or abuse and immediately inform management of
such issues.
- Stays abreast of changes in regulations and practices, policies and procedures.
- May submit requests for re-determination files and completed reconsideration and Administrative
Law Judge (ALJ) reputed company to relevant entities.
- Participates in special reputed company and performs other duties as assigned.
DRA Job reputed company 1/13/2025 Experience / Expertise:
- One (1) years of experience with Provider disputes or claims
- One (1) years of interaction with claims with larger insurance plans
- One (1) year of general office or administrative experience
- Experience directly relevant to the specific task order or project, preferred
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