JOB SUMMARY:

The Claims Arbitration Liaison serve as the liaison for health plan and provider disputes in an effort to resolve claims issues within the applicable timeframe. Tasks include but not limited to arbitration support, standard post claims adjustments based on TDI Arbitration adjustment request amounts and or agreed upon negotiated rates.

MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure: High School Graduate, GED or equivalent.

2. Work Experience (Years and Area): 6mo - 2 years of claims adjustment experience with professional, inpatient and outpatient claim for multiple lines of business (i.e. Marketplace, Commercial, Medicare, Medicaid) Claims Arbitration experience (preferred)

3. Management Experience (Years and Area): N/A

4. Software Operated: Microsoft Office Suite

5. Other Requirements:
Computer literate and basic knowledge of claims software usage.
Basic knowledge of medical procedures and terminology, medical CPT, ICD-10, DRG and Healthcare Common Procedure Coding System (HCPCS).
Sound analytical problem-solving and documentation skills.
Ability to speak, listen and write effectively.
Quick learner with the ability to adjudicate professional and facility claims, applying appropriate reimbursement methodologies.
Ability to problem solve and work independently.
Team player with the ability to establish and maintain effective work relationships.


SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Writing /Composing (Correspondence / Reports)

2. Other Skills:
Analytical
Mathematics
Medical Terminology
Research
MS Word


3. Advanced Education: N/A


4. Work Schedule: Weekdays, Flexible


RESPONSIBLE TO: Supervisor/Manager

EMPLOYEE SUPERVISED: None