Arbitration Specialist III - Remote

Overview

The Arbitration Specialist III is responsible for the review, investigation, and reopening of closed out-of-network disputes utilizing the Federal independent dispute resolution processes, known as “arbitration”, including assessing whether errors occurred in dispute closure and pursuing corrective action when appropriate. At this time, US Anesthesia Partners does not hire candidates residing in California, Hawaii, or Alaska. Job Highlights ESSENTIAL DUTIES AND RESPONSIBILITIES: (The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation)

• Investigates closed Federal and State arbitration disputes to determine whether an error occurred in the dispute closure, including clerical, procedural, or eligibility-related errors.
• Analyzes case details, submission history, portal activity, correspondence, and determinations to assess whether closures align with applicable CMS technical assistance.
• Evaluates closed disputes for potential reopening or correction, applying CMS guidance on errors identified after dispute closure and other applicable regulatory standards.
• Prepares, documents, and submits reopening or correction requests including justification and supporting documentation.
• Monitors and manages post-closure timelines and deadlines according to operational guidelines associated with reopening requests, corrections, and follow-up actions to ensure compliance.
• Serves as a primary resource for post-closure dispute review, advising management on whether a case warrants escalation, reopening, or no further action.
• Researches and responds to inquiries from CMS, IDR entities, arbitrators, or Departments of Insurance related to closed disputes and reopening requests.
• Maintains detailed electronic records of post-closure investigations, findings, submissions, and outcomes to support audit readiness and internal review.
• Identifies and communicates trends, recurring closure issues, and systemic risks related to improper closures, portal errors, or inconsistent application of arbitration rules.
• Partners with arbitration leadership, compliance, and legal teams to develop strategies for preventing repeat closure errors and improving internal quality controls.
• Acts as a point of contact for management on reopened or post-closure cases, providing clear summaries, risk assessments, and recommended next steps.

Qualifications

KNOWLEDGE/SKILLS/ABILITIES (KSAs):

• High school diploma or equivalent.
• 3-4 years of related experience.
• Excellent written and verbal communication skills.
• Intermediate skills in arenaflex Word and Excel is required.
• Ability to be detail oriented and organized with ability to prioritize.
• Prior healthcare experience and/or appeal work is a plus.
• Advanced level skill in computer applications including MS Word and MS Excel.
• Advanced knowledge of payor processes and healthcare billing. Anesthesia experience preferred.
• Must display teamwork attitude and good inter-personal skills.
• Organized with strong attention to detail.
• Ability to prioritize and organize work and projects to ensure focus on high impact/value-added activities and meet deadlines.
• Ability to identify trends to gain efficiencies in day to day work; sharing knowledge with colleagues.
• Ability to communicate effectively in writing.
• Ability to work independently with limited supervision.
• Willing to learn new processes.
• Knowledge of basic medical terminology and concepts preferred.
• Knowledge of CPT, ICD-9, and ASA coding preferred.
• Ability to effectively work well under pressure in a fast-paced environment.
• Assist with special projects and perform other duties as assigned.
• The physical demands described here are representative of those that may need to 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.
• Occasional Standing
• Occasional Walking
• Frequent Sitting
• Frequent hand, finger movement
• Use office equipment (in office or remote)
• Communicate verbally and in writing US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors. Apply tot his job Apply tot his job

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