IDR Arbitrator

Description

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

Commence is seeking a highly skilled and detail-oriented Arbiter to join our team. The Arbiter will be responsible for arbitrating/deciding payment disputes, analyzing documentation, and managing case files. The ideal candidate has a strong understanding of Microsoft systems and excellent writing skills.

Requirements

• This role is primarily responsible for arbitrating/deciding payment disputes, but may also determine jurisdictional issues
• Review all dispute-relevant information; request additional information as authorized and required; decide as to whether the initiating party or non-initiating party will be awarded the arbitration decision
• The arbiter must remain neutral when analyzing the materials provided, and must be able to write a concise determination in a short period of time to meet deadlines
• Review cases to determine and summarize facts of each case assigned and assess issues involved in the case
• Collaborate with other technical and legal professionals, requesting and dispensing assistance as needed, verbally and in writing, to reach the most appropriate decision
• Research jurisdictional and substantive issues using federal and state law and regulations as they pertain to the No Surprises Act of 2020 and the Federal Independent Dispute Resolution Entity program.
• Interpret applicable regulations and policies associated with the case to determine the appropriate decision, both concerning jurisdiction and the merits
• Communicate the determination in a clearly written format
• Exercise independent judgment to ensure determination is accurate, well supported, and defensible; take appropriate action as required
• Draft and/or edit and review determination decisions
• Perform other duties as may be assigned by management

Qualifications & Experience:

• Juris Doctorate preferred
• Certified in Arbitration is preferred, required within the year
• Ability to perform comfortably in a fast-paced, deadline-oriented work environment
• Excellent organizational, interpersonal, written, and communication skills
• Ability to work as a team member, as well as independently
• Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products

Organizational "Fit" Considerations:

Schedules may vary and may include weekend and holiday shifts. This position requires established, professional relationships with internal personnel at all levels within the company and with beneficiaries, representatives, providers, and other stakeholders.

Work Environment/Physical Demands

The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is an office/remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

This is a remote position. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

Commence is an equal employment opportunity employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or [email protected]. Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.