Jurisdictional Analyst

Job Type

Full-time

Description

The Jurisdictional Analyst will assist with the validation of disputes and documentation between non-governmental health plans and providers. Will be required to quickly and efficiently prepare, review, and submit well-written conflicts of interest, documentation sufficiency, and jurisdictional determinations on disputes, and perform any other administrative or legal duties as may be necessary. Will have to work well with attorneys, paralegals, nurses, and coders. Must be a team player and work well under pressure.

This position will primarily support the work associated with Independent Dispute Resolution (IDR) cases as part of the No Surprises Act which outlines a process for resolving payment disputes between out-of-network or air ambulance providers or facilities and health plans for how much the out-of-network provider, air ambulance company, or facility will be paid for the services associated with a case when surprise billing protections apply.

Requirements

• Determine whether a corporate conflict of interest prevents Livanta from reviewing the dispute.
• Screen out cases covered by a prior decision involving the same parties within the designated time limit, i.e., the 90-day cooling off period.
• Determine whether other regulatory timeframes that are a prerequisite for jurisdiction have been met.
• Determine whether the case jurisdiction is state or federal.
• Write appropriate jurisdictional determinations. In cases in which federal jurisdiction is appropriate, include any other information noted that would be useful to the medical coders, nurses, and legal arbitrators in determining the resolution of the disputed claim in the determination.
• Demonstrate experience in prioritizing work and determining when to bring issues, concerns, or discrepancies to the supervisor's attention.
• Review medical records to assist in the final IDR determination.
• Understand, in general, how healthcare insurance functions.
• Understand state and federal medical and jurisdictional laws applicable to the IDR process.
• Exercise discretion to address potential issues before they become problems.
• Protect the confidentiality of patient information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH).
• Attend annual security awareness training and testing, rules of conduct, and conflict of interest training.
• Perform other duties as assigned.
  
  

Essential Knowledge

• Display knowledge of how insurance claims are processed including an understanding of medical coding and claim rejections that assist in determining a case that is part of the IDR process.
• Medical coding certification is preferred.
  
  

Essential Education

Associate degree with a major in paralegal studies or a bachelor’s degree in legal services or business administration with a major in paralegal studies and/or a Paralegal certification. Relevant experience can be substituted for formal training requirements.

Essential Skills

• Exhibit excellent attention to detail, strong proofreading and organizational skills, and excellent oral and written communication with internal parties.
• Must simultaneously manage several projects, task functions, and complex contractual requirements.
• Proficient in Microsoft Office, including Word and Excel.
• Highly attentive to detail and excellent organizational and time management skills
• Clear, concise, and logical writing style.
• Display the qualities of an efficient multi-tasker who can manage competing demands with differing deadlines and work well with attorneys, professionals, and other staff.
  
  

Livanta LLC is an equal employment opportunity employer. All personnel processes are 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.

If you need assistance or an accommodation due to a disability, you may contact us at 757-306-4920 or [email protected].