NSA Strategy Team Lead

JOB SUMMARY: This position leads the team responsible for evaluating complex provider claims disputes specific to NSA (No Surprise Act Legislation) to include developing and monitoring recommendations for client payment offers. In addition to managing a substantial arbitration case load, this role works with the leadership team to assure that the arbitration team meets its performance metrics, quality performance, and business objectives. The incumbent is responsible for ensuring all client payment offers are submitted to CMS according to the defined schedule in the offer link to avoid client default. This role manages an arbitration case load including evaluation of provider disputes and appropriate client payment offers. The incumbent will coordinate efforts with the team and leadership to bring matters to efficient and successful outcomes.

JOB ROLES AND RESPONSIBILITIES:

1. Work with Sales, HCE, Data Science Team and Manager, to develop and refine the appropriate amount of payment amounts that a client should offer to CMS during the Arbitration process
a. Should include monitoring success rates of submissions and working with Analytics team to alter these amounts based on results from specific IDREs (Independent Dispute Resolution Entities)
2. Review, monitor and analyze all aspects of brief submissions are handled appropriately to include ensuring all objections are called out during the final offer submission
3. Maintain templates of legal briefs required for submission to CMS during the Arbitration process. Draft legal briefs and offers persuasively documenting arguments to support client positions in arbitration packages pursuant to federal and state regulations
4. Monitor offer due dates to ensure all offers are submitted according to the date required by CMS. Work with team members with managing case loads and ensuring no dates are missed preventing default by our clients. Including monitoring staffing levels to ensure the team is adequately staffed to handle volumes.
5. Meet federal and state filing deadlines and turnaround times
6. Identify, design and execute training needs on an individual basis. Discuss training needs for the team with manager and provide continuous coaching of the staff so they perform at the highest levels.
7. Perform additional administrative tasks such as monitoring team chat's or emails for questions, participate in team meetings for response to team questions or help identify issues.
8. Host weekly or bi-weekly Team Huddles for case discussion and review.
9. Prepare written analyses of disputed provider/health plan positions and persuasively document arguments supporting client positions in arbitration packages pursuant to federal regulations.
10. Conduct due diligence (e.g. online research, portal and application research) to assist with the analysis and preparation of arhipaabitration packages.
11. Works with other departments to develop or obtain information necessary for the submission of IDR packages.
12. Review and analyze clinical information along with documents submitted by providers of moderate to high complexity.
13. Meet federal filing deadlines and turn around times
14. Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; maintain detailed and accurate records.
15. Outreach to clients for data needed for arbitration packages
16. Maintain department productivity and quality standards
17. Sensitivity to privacy in accordance with HIPAA guidelines
18. Collaborate, coordinate, and communicate across disciplines and departments.
19. Ensure compliance with HIPAA regulations and requirements.
20. Demonstrate Company's Core Competencies and values held within.
21. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE: Keep the needs of external and internal customers as a priority when making decisions and taking action. Operates independently under limited supervision. Has decision making authority within specified parameters and must engage advice and/or help of manager to proactively resolve cases. Works across customers, beneficiaries, providers, and supplemental payors while maintaining positive relationships. The incumbent must be open to feedback, teamwork and show interest in contributing ideas to improve organizational processes. Guides the others on the team, provides coaching, provides and prioritizes work load across the team.