Jurisdictional Analyst

Job Summary

A company is looking for a Jurisdictional Analyst to assist with validating disputes and documentation between health plans and providers.

Key Responsibilities

• Prepare, review, and submit documentation related to disputes and conflicts of interest
• Determine jurisdictional matters and regulatory timeframes for cases
• Review medical records to support Independent Dispute Resolution (IDR) determinations

Required Qualifications, Training, and Education

• Associate degree in paralegal studies or a bachelor's degree in legal services/business administration with a major in paralegal studies
• Paralegal certification is preferred
• Relevant experience may substitute for formal training requirements
• Understanding of healthcare insurance functions and medical coding
• Knowledge of state and federal medical and jurisdictional laws applicable to the IDR process