Regulatory Compliance Analyst - Baltimore, MD

Only for registered members Baltimore, MD, United States

2 weeks ago

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Job summary

The Regulatory Compliance Analyst will conduct independent analysis and determination regarding the eligibility and legal appropriateness of provider open negotiation requests and independent dispute resolution initiations (IDRs) for No Surprises Act (NSA) and state NSA cases.
  • Review and analyze to determine eligibility and to develop substantive argument to support CareFirst CIDRE selections/eligibility and offers on IDRs.
  • Oversees the end-to-end process of the billing vendors and dispute resolution claim submissionand payment requests. This includes the maintenance of the NSA tracking databaseand claims resolution from start to finish. Monitors claims, identify trends,presents opportunity areas, and prioritizes initiatives for performance improvement. Tracks outcomes of payment resolutionand negotiated claims to ensure goals are met.

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