IDR Dispute Resolution Manager

IDR Dispute Resolution Manager

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

JOB SUMMARY

This position is responsible for the oversight and direction of the Arbitration solution. This position is responsible for providing leadership and decision making to ensure high quality service is provided to account management, clients, providers, IDR entities and CMS client's internal customers and vendor relationships. Also responsible for managing or overseeing the management of all activities with the associated units, including developing and implementing policies and procedures on all related systems and work flows to ensure achievement of the department's service and quality standards. The Manager is responsible for directing staffing, goal tracking and compliance with policies and procedures to ensure smooth and efficient operations. This job will also interact with other organizational departments and participate in client calls.

DUTIES

1. Direct management of performance to ensure competent staff delivers quality and timely results. This includes training, mentoring, motivating, and overseeing staff performance.
   2. Develop, implement and manage policies and procedures based on current and future trends and legislative requirements. Stay abreast of industry and/or customer changes and communicate as appropriate.
   3. Compile, analyze, and report on trends to include performance improvement initiatives and exceptional client delivery.
   4. Identify opportunities for performance improvement and operational efficiencies.
   5. Act as a subject matter expert internally for the Team and other departments within the Company.
   6. Select, develop, and evaluate staff to ensure the efficient operation of department.
   7. Collaborate, coordinate, and communicate across disciplines and departments.
   8. Ensure compliance with HIPAA regulations and requirements.
   9. Demonstrate Company's Core Competencies and values held within.
   10. 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. Perform weekly Soft Audits on cases work by team members and address performance issues.

JOB SCOPE:

The Manger provides input to make critical business decisions, including staffing and process improvement, and impacts day-to-day operations through the oversight of Dispute resolution and providing direction to staff on individual cases. The incumbent operates with considerable latitude for resolving Disputes and uses an extensive range of knowledge to complete job responsibilities. The incumbent manages staff and helps provide thorough and appropriate responses to clients and providers to meet the goals of the department. This role has the authority to recommend and implement appropriate policies, procedures and controls to assure compliance with applicable contractual provisions, regulations, and legislation. This position manages others and has the authority for all HR actions (hiring, firing, discipline, training, etc.)

COMPENSATION

The salary range for this position is $75-90K. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.