Arbitration Manager

Role Overview

The Arbitration Manager leads and manages a team responsible for handling disputes through the Federal Independent Dispute Resolution (IDR) mechanism and applicable state arbitration or mediation processes mandated under the No Surprises Act. This leadership position ensures team performance excellence, case quality, and adherence to service level agreements throughout negotiation, IDR initiation, and payment determination phases. Acting as the primary escalation resource, the manager handles complex matters involving eligibility, jurisdiction, and communications with dispute resolution entities. Reporting to the Director of Federal IDR Operations, this role is central to expanding arbitration capabilities in response to increasing claim volumes.

Key Duties and Responsibilities

• Supervise daily activities, manage assignments, and productivity of Arbitration Specialists working on Federal and state-specific dispute cases.
• Ensure the precision and quality of negotiation notices, Federal IDR initiation documents, eligibility assessments, and supporting materials such as Explanation of Benefits (EOBs), Qualifying Payment Amount (QPA) disclosures, and negotiation communications.
• Monitor compliance with all dispute lifecycle phases, including the 30-business-day negotiation period, 4-business-day IDR initiation window, and response deadlines dictated by the Independent Dispute Resolution Entity (IDRE).
• Serve as the go-to authority for escalation related to complex jurisdiction questions, eligibility for batching, coordination of benefits issues, and supplemental information requests from IDRE.
• Approve critical or high-value disputes before submission, covering Federal IDR proofs and state arbitration filings.
• Track both team and individual performance metrics such as cases filed, success rates, average recovery improvements, and cycle times, reporting these trends to senior management.
• Identify inefficiencies or gaps in existing processes and propose updates to policies and procedures related to IDR, ensuring alignment with evolving regulations and feedback from IDRE.
• Lead training and development for Arbitration Specialists, including onboarding new team members and maintaining knowledge currency on No Surprises Act and relevant state legislation requirements.
• Collaborate with Eligibility Specialists and fellow managers to guarantee smooth transition of eligible claims into arbitration workflows.
• Maintain up-to-date understanding of Federal IDR regulations (45 CFR 149.510), CMS-9897-F batching rules, QPA methodologies, and applicable state IDR laws such as Texas SB 1264 and Illinois 215 ILCS 5/356z.3a.

Required Qualifications

• A minimum of 3 years’ experience in healthcare revenue cycle management, dispute resolution between payers and providers, or No Surprises Act IDR processes, including at least one year in a supervisory or leadership role.
• Proficient knowledge of the No Surprises Act, Federal IDR process, and QPA calculation methods, with additional familiarity of state-level arbitration processes considered advantageous.
• Strong capability in managing substantial workloads and meeting critical deadlines under high-volume conditions.
• Excellent written communication skills, including preparation of formal dispute correspondence targeting payers and IDR organizations.
• Competency working with claims data and Explanation of Benefits documents, along with proficient use of office software such as Microsoft Excel; experience with case management or IDR portals is preferred.
• Preferred Bachelor’s degree or a comparable combination of education and relevant professional experience.

Success Measures

• Adherence to service level agreements across negotiation and IDR initiation timelines.
• High case win rates and favorable financial recovery outcomes relative to initial payer determinations.
• Quality assurance measures reflecting eligibility accuracy and comprehensive documentation.
• Efficient team productivity aligning with capacity and throughput targets.

Additional Information

This job description outlines the principal duties and expectations associated with the position but is not exhaustive of all tasks or skills required. The role requires a commitment to evolving compliance standards and operational excellence within the healthcare dispute resolution framework.