Description & Requirements
This role is primarily responsible for arbitrating payment disputes between providers, facilities, or providers of air ambulance services, and group health plans, health insurance issuers/carriers. It is essential to remain neutral when analyzing the materials provided, and to be able to write a concise determination in a short period of time. Essential Duties and Responsibilities:
- Provide legal research, guidance, advice, leadership, and training to project staff, ensuring compliance with all project and client policies/procedures, laws, and regulations.
- Interact with the client regarding case decisions.
- Guide teams to ensure all major client/legal requirements are met and relevant documents are captured accurately.
- Provide self-directed legal support to the project leadership.
- Process and resolve high profile and complex cases.
- Manage direct reports, including hiring, setting monthly individual/team goals, and evaluating employee performance.
- Reviews all credible documentation received from involved parties regarding their proposed payment amount and renders an independent payment determination, by selecting one of the two submitted offers with rationale behind determination.
- Review eligibility determinations based on Federal and State guidelines.
- Draft and review payment determination decisions.
- Create policy documentation, processes, procedures, and job aids for administrative staff.
- Serve as a subject matter expert regarding surprising billing regulations.
- Communicate with project staff regarding regulatory/legal questions, opinions, and interpretations.
- Act as an advisor on regulatory/legal issues involving compliance.
- Draft email responses to payment dispute questions or concerns from the disputing parties.
- Coordinate with internal counsel for litigation and legal matters, as needed.
- Interpret applicable regulations and policies associated with case to determine recommendation.
- Ensure solutions are consistent with organizational objectives.
- Juris Doctor from an accredited law school. Licensed attorney, preferred.
- Familiar with Surprise Billing regulations, rules, and policies; and claims Arbitration procedures/practices.
- 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.
- Healthcare Law experience, highly preferred.
- Litigation experience, preferred.
- Legal writing experience, preferred.
- Medical coding experience, preferred. Minimum Requirements:
- JD preferred
- 3-5 years of relevant professional experience required.
- Equivalent combination of education and experience considered in lieu of degree.
- Minimum of 3-5 years of arbitrating or adjudicating medical claims.
- Ability to perform comfortably in a fast-paced, deadline-orientated work environment. Home Office Requirements:
- Hardwired internet (ethernet) connection
- Internet download speed of 25mbps or higher required (you can test this by going to
- Private work area and adequate power source
- Computer/Laptop (no tablets or Chrome books)
Minimum Requirements
Minimum Requirements:
- Juris Doctorate from an accredited law school required.
- 3-5 years of related professional experience.
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.
Pay Transparency
Maximus 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 Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus 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. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.
