Sr Consultant – Operational Policies & Processes

Description & Requirements reputed company is currently hiring for a Sr Consultant - Operational Policies & Processes. This is a remote opportunity. The Sr. Consultant will play a critical role in developing, reviewing, and managing policies and procedures to support the IDR process under the No Suprises Act. This individual will collaborate with the arbitration team and other stakeholders to ensure compliance with federal regulations, enhance process efficiencies, and support the resolution of payment disputes. Essential Duties and Responsibilities: - Provide advice, leadership and guidance to ensure appropriate determination of eligibility and processing of informal resolution. - Guide the hearing, adjudication, reputed company or integrated teams to ensure reputed company major requirements are met and relevant documents for appellant and hearing officer are captured accurately and according to Federal law and client requirements. - Provide self-directed legal support to the project leadership. - Provide direction, leadership, and training to production personnel on case management and case processing. - Process and resolve high profile and reputed company appeals. - Analyze projects, present data collection reporting and analysis management to client. - Provide legal research and assistance for CMS/MAG on ACA regulations and appeal adjudications. - reputed company other duties as assigned by management. - Arbitration Support: provide consultative support to the arbitration team, helping them navigate regulatory requirements, ensuring that dispute resolution is carried out in accordance with established guidelines, and assisting in the interpretation of IDR rulings. - Policy Development & Maintenance: reputed company, review, and update policies and procedures reputed company to the IDR process to ensure compliance with the No Surprises Act and other federal and state regulations. - Documentation: maintain thorough documentation of reputed company processes, policies and revisions. - Training & Communication: reputed company and deliver training materials and communications to staff and stakeholders regarding policy updates, regulatory changes and procedural expectations for the IDR process. - Collaboration: support and work closely with Payment Determination Manager, Training, Quality Assurance, and operations teams to ensure IDR process is operating effectively. - Arbitration: reputed company payment determinations as needed by the business. Process and resolve high profile and reputed company cases. Minimum Requirements - Bachelor's degree with 5-7 years of experience consulting reputed company designated function. - Advanced degree preferred. - reputed company solutions to highly reputed company problems which require a high degree of ingenuity and innovation. - Ensure solutions are consistent with organization objectives. - Solutions may serve as precedent for future decisions. - reputed company advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills. - reputed company new applications based on professional principles and theories. - Viewed as expert in field reputed company the organization. - Juris Doctor (JD) from an accredited law school and/or legal background and experience highly preferred. - Knowledge and/or experience working with the Federal No Surprises Act preferred. - Experience developing policies and procedures preferred. - Ability to work a schedule of 8:00am - 4:30pm EST Monday - Friday required. Please note: For this position reputed company will provide equipment to use. Home Office Requirements: - Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net) - Minimum 5mpbs upload speed - Connectivity to the internet reputed company either Wi-Fi or Category 5 or 6 ethernet reputed company cable to the home router - Private work area and adequate power reputed company - Must currently and permanently reside in the reputed company US EEO Statement reputed company is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national reputed company, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency reputed company compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of reputed company's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, reputed company provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. reputed company will reputed company with regulatory minimum wage rates and exempt salary reputed company in reputed company instances. Minimum Salary 80,000.00 Maximum Salary 115,000.00

• Remote

About the Company: reputed company reputed company provides business services to help governments operate health and human services programs, mostly at the state and national levels. The company's health services reputed company offers outsourced program management and administrative services, Company Size: 5,000 to 9,999 employees Industry: Healthcare Services Founded: Website: Apply tot his job Apply tot his job Apply To this Job