Overview

The Remote Out-of-Network Arbitration Representative is responsible for completing all processes related to thr Open Negotiation and IDR processes for eligible out-of-network accounts. Both Federal and State regulations must be considered and applied in the preparation of these materials. Applications to be utilized include, but are not limited to: Microsoft Office applications, GPMS, Waystar, the Internet, and Origami.

Responsibilities

• Prepare Open Negotiation notices for all qualifying charges.
• Document disputed charge information using standard template.
• Utilize standard Pediatrix criteria to prepare initial offer for out-of-network rate.
• Submit Open Negotiation notice through appropriate payer channels.
• Maintain electronic folder(s) of all Open Negotiations filed to serve as a historical audit repository and for tracking/trending purposes.
• Follow up on pending Open Negotiations.
• Confirm receipt of Open Negotiation request.
• Document status of Open Negotiation request within 30 days.
• Ensure that charges not resolved through Open Negotiation are routed to the appropriate channel for further follow-up, as needed.
• Develop and maintain a working knowledge of Open Negotiation guidelines and payer specific requirements.
• Maintain a complete understanding of the appropriate follow-up protocols and required software programs.
• Meets productivity and quality measurement standards as set forth by the Out of Network Arbitration Department.
• Maintains strict confidentiality in accordance with HIPAA regulations and Company policy.
• Any patient private health information (PHI) must not be divulged on any account except to payers that need the information to process the claim for payment.
• Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.

• Performs other job-related duties within the job scope as requested by Management of OON Arbitration.

• Complies with departmental and company-wide policies and procedures.

Qualifications

Associate's degree (A. A.) or equivalent from two-year college or technical school; or one to two years related experience and/or training; or equivalent combination of education and experience.

Benefits and Compensation

Benefits for Full Time employee and qualified dependents:

• Health Insurance including prescription drugs
• Dental Insurance
• Vision Insurance
• Life Insurance
• Short- and Long-Term disability options
• Employee stock purchase program – 15% discount*
• 401k with company match**
• Long Term Care (LTC)
• Pre-tax Health Savings Account (HSA)
• Pre-tax Flexible Spending Accounts (FSA)
• Aflac Hospital, Critical Illness and Accident plans
• Identity Protection
• Employee Assistance Program (EAP)

*Part Time Regular employee classifications also receive this benefit.

** Available to part-time regular and part-time casual employees age 21 and over.

About Us

Pediatrix® Medical Group, Inc. (Pediatrix) is the nation’s leading provider of physician services. Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices. Specialties include obstetrics, maternal-fetal medicine and neonatology complemented by more than 20 pediatric subspecialties, as well as pediatric primary and urgent care clinics. The group’s high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives. The physician-led company was founded in 1979 as a single neonatology practice and today provides its highly specialized and often critical care services through more than 5,000 affiliated physicians and other clinicians in 37 states. 

Please Note: Fraudulent job postings/job scams are becoming increasingly common. All genuine Pediatrix job postings can be found through the Pediatrix Careers site: www.pediatrix.com/careers.

Pediatrix is an Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.