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.
Arbitration Specialist III
Location
United States
Posted
50 days ago
Salary
$24 - $39 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Arbitration Specialist III
US Anesthesia Partners, Inc.
Role Description 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. The base pay estimate for this role is $24.13 - $38.65 hourly. The final offer will depend on the skills, experience, and qualifications of the selected candidate. This range is for base pay only and does not include bonuses or other compensation. This position is eligible for an annual bonus. Bonuses are not guaranteed and are awarded based on company and individual performance. Qualifications - High school diploma or equivalent. - 3-4 years of related experience. - Excellent written and verbal communication skills. - Intermediate skills in Microsoft 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. Requirements - 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. Benefits - This position is eligible for an annual bonus. Bonuses are not guaranteed and are awarded based on company and individual performance.
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Grand Canyon EducationGrand Canyon Education (GCE) is a rapidly growing educational service company that has long been an industry leader in providing educational, operational, and technological support services to the post-secondary education sector. Formerly part of Grand Canyon University (GCU), GCE still works closely with GCU to benefit thousands of students, families, and the local inner-city community. We put people first, drive innovation, and do good in the community that we live and work in.
Come Grow With Us Grand Canyon Education (GCE) is a rapidly growing educational service company that has long been an industry leader in providing educational, operational and technological support services to the post-secondary education sector. Formerly part of Grand Canyon University (GCU), GCE works in partnership with GCU to benefit thousands of students, families and the local inner-city community. We put people first, drive innovation, and do good in the community that we live and work in. Grand Canyon Education is currently seeking a Transcript Specialist to support the Student Records department. This role is responsible for complete and accurate data entry of all transcripts received. Responsibilities: - Responsible to enter every line noted on an official transcript received for a student. - Responsible to identify transcript and associate with the appropriate student record in CampusVue, our student database. - Responsible to maintain status of transcript receipts in CampusVue. - Responsible to key in all data on incoming transcripts. - This is a full time work from home position. - Other duties as assigned. Qualifications: - High school or high school equivalency diploma required. Bachelor’s degree from a regionally accredited institution is preferred. - Minimum one year of work experience in administrative area, higher education preferred. - Ability to type 50+ WPM. - Attention to detail and a high level of accuracy in data entry. - Good interpersonal and communications skills with the ability to work effectively with people of diverse cultural backgrounds and/or in team environments. - Good written communications skills with a good command of the English language. - Ability to identify inaccuracies and resolve through ability to fact find and research. - Ability to multi-task and adapt to changing priorities. - Proficient with MS Office Suite including Excel spreadsheets and a familiarity with software databases is helpful. - Knowledgeable of CampusVue, or similar student information software is preferred. - Must maintain a high degree of business ethics and integrity. - Must maintain confidentiality of information. - Must pass pre-employment background checks.
E-Referral Specialist Home Health
CenterWellCenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. Cares for patients with chronic and complex illnesses. Offers personalized clinical and educational services to improve health outcomes and drive superior medication adherence. CenterWell, a Humana company, creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and the fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional, and social wellness of our patients. Part of Humana Inc. (NYSE: HUM). Offers stability, industry-leading benefits, and opportunities to grow yourself and your career. Employs more than 30,000 clinicians committed to putting health first. Provides flexible scheduling options, clinical certifications, leadership development programs, and career coaching.
Become a part of our caring community Shift/Availability Requirements: - This is a full time position scheduled for 40 hours, 5 days a week for 8 hour shifts. - Days of availability are Monday-Friday. - Hours of availability are from 8:30am-5pm CST. - Weekend coverage may be required based on business needs. - Available to work 2 holidays a year. Based on business needs, additional holiday coverage may be required. As an E-Referral Specialist you will report to the E-Referral Supervisor. You will be an important part of the referral process as this role is the initial contact point for the client or referral source to promote the continuity of care. You will be responsible for data collection and documentation, compliance, and follow up on the initial referral process and decision. Essential Functions you will be responsible for: - Monitor multiple e-referral systems to identify new referrals and manage alerts and notifications. - Monitor email for request to pull referrals from all applicable referral systems. Perform follow-up and manage all related communication. - Scan documentation to determine patient eligibility for services (service area, orders, insurance, etc.) - Help with authorizations. - Monitor status of all referrals received, follow up with each throughout process, reports on status weekly. - Communicate with branch, sales, leadership by email or phone for status updates and referral decisions. - Daily management of ERST log with all referrals and ROCs decisions. - Maintain acceptable productivity level, as determined by work assignment and departmental standards. - Comply with and follow all regulatory compliance areas, policies & procedures, and company best practices. Use your skills to make an impact Required Experience: - High School Diploma or its equivalent - Can type a minimum of 40 wpm - Comprehend and apply principles of basic math while analyzing data and generating reports - Good logical thinking and decision-making skills - Can follow strict timelines - Communication with all levels of management - Can work with multiple screens/systems ensuring attention to detail - Time management skills and can work in a fast-paced environment - Must read, write and speak fluent English - Must have good and regular attendance - Approximate percent of time required to travel: 0% Preferred Experience: - Patient referral and insurance verification experience - Minimum 1 year customer service or other healthcare related experience; preference working in a home health environment - Knowledge of the issues related to the delivery of home health services - Working knowledge of Medicare enrollment and guidelines governing home health agencies - Associates degree Additional Information: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. - Satellite, cellular and microwave connection can be used only if approved by leadership. - Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. 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Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 04-14-2026 About us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
JOB SUMMARY The Poison Information Specialist works under the general supervision of the Business Operations Manager, Managing Director, as well as the Medical Director. The Poison Information Specialist is a health care professional who assumes responsibility and accountability for the assessment and disposition of a poisoned or potentially poisoned patient. Serves as a knowledgeable resource to the public, health care professionals, and public health entities for incoming inquiries regarding medication, poisoning, chemical, toxin, or other public health emergencies. Provides most care by telephone via the use of individual expertise and training, triage process, the environmental conditions, technology support through specialized toxicology data bases and other health care team members, including consultants. Responsible for performing job duties in accordance with mission, vision, and values of Tampa General Hospital. - Graduate of an accredited school of Pharmacy, Nursing or Medicine with a Baccalaureate or Doctorate Degree. - Current licensure as a Registered Nurse or Registered Pharmacist. - Must obtain national certification by American Association of Poison Control Centers (AAPCC) as a Certified Specialist in Poison Information (CSPI) within first 3 years of employment. - Three (3) years recent experience as a professional nurse, pharmacist, or physician, with a background in emergency medicine, critical care, or pediatric experience is preferred. - Must be qualified to understand and interpret standard poison information resources and to transmit that information in a logical, concise, and understandable way to both health care professionals and the public.
JOB SUMMARY The Poison Information Specialist works under the general supervision of the Business Operations Manager, Managing Director, as well as the Medical Director. The Poison Information Specialist is a health care professional who assumes responsibility and accountability for the assessment and disposition of a poisoned or potentially poisoned patient. Serves as a knowledgeable resource to the public, health care professionals, and public health entities for incoming inquiries regarding medication, poisoning, chemical, toxin, or other public health emergencies. Provides most care by telephone via the use of individual expertise and training, triage process, the environmental conditions, technology support through specialized toxicology data bases and other health care team members, including consultants. Responsible for performing job duties in accordance with mission, vision, and values of Tampa General Hospital. - Graduate of an accredited school of Pharmacy, Nursing or Medicine with a Baccalaureate or Doctorate Degree. - Current licensure as a Registered Nurse or Registered Pharmacist. - Must obtain national certification by American Association of Poison Control Centers (AAPCC) as a Certified Specialist in Poison Information (CSPI) within first 3 years of employment. - Three (3) years recent experience as a professional nurse, pharmacist, or physician, with a background in emergency medicine, critical care, or pediatric experience is preferred. - Must be qualified to understand and interpret standard poison information resources and to transmit that information in a logical, concise, and understandable way to both health care professionals and the public.