The NAI

Attorney

• This role is primarily responsible for arbitrating/deciding payment disputes
• The arbiter must remain neutral when analyzing the materials provided, and must be able to write a concise determination in a short period of time to meet deadlines
• Review cases to determine and summarize facts of each case assigned and assess issues involved in the case
• Research issues using federal law, federal regulations, relevant contract law
• Review plan contracts and other relevant information; make a decision as to whether an enrollee is entitled to benefits in cases involving contractual disputes
• Communicate the determination in a clearly written format
• Exercise independent judgment to ensure determination is accurate, well supported and defensible; take appropriate action as required
• Acquire all necessary information involving cases and render final determination based on the information provided by the appellant
• Manage highly complex case files
• Perform other duties as may be assigned by management
• Draft and review payment determination decisions
• Draft email responses to payment dispute questions or concerns from the disputing parties
• Interpret applicable regulations and policies associated with case to determine recommendation
• Ensure solutions are consistent with organizational objectives

Arbiter Attorney

• Arbitrating/deciding payment disputes
• Analyzing documentation and managing case files
• Reviewing cases to determine and summarize facts of each case assigned
• Researching issues using federal law and relevant contract law
• Communicating the determination in a clearly written format
• Drafting and reviewing payment determination decisions

Arbiter Attorney

Arbiter Attorney – 1099 Contract