Position Description: Stakeholder Engagement JD/Subject Matter Expert (SME)Under the direction of the Independent Dispute Resolution Entity (IDRE) Executive Director or his/her designee, the Stakeholder Engagement JD/Subject Matter Expert (SME) serves as the "face" of PRITM's IDR program. The Stakeholder Engagement JD/Subject Matter Expert (SME) applies their knowledge of and experience in arbitration, dispute resolution, federal and state law, regulatory guidance and application of policies to oversee and carry out the stakeholder engagement and outreach activities related to PRITM's IDRE program. The Stakeholder Engagement JD/Subject Matter Expert (SME) serves as a trusted party representing PRITM's interests as well as the interests of stakeholders, e.g., providers, plans, payers, government, etc., in communicating IDRE decisions in accordance with applicable state or federal law. Must be experienced in engagement and communication with various members of the health community from an educational perspective. Must be able to communicate in a clear manner when explaining the relationship of applicable laws to specific disputes throughout the program and with stakeholders.The Stakeholder Engagement JD/Subject Matter Expert (SME) oversees a multidisciplinary Engagement Team (e.g., paralegal, attorneys, project coordinator, eligibility and payment team members) that handle Request for Information (RFI) responses, withdrawals, settlements, complaints and other IDRE calls and emails that require follow up. The Stakeholder Engagement JD/Subject Matter Expert (SME) serves as the lead individual working with stakeholders and therefore must be able to independently research decisions and communicate outcomes. In addition, this individual identifies patterns and trends in correspondence data and works collaboratively with Senior Management to implement corrective action plans and evaluate program performance.Responsibilities:
Understand and represent PRITM's mission, vision, and values to all internal and external customers
Interact with government and private sector clients, partners, and PRITM staff in a professional and accountable manner, and as a representative of PRITM management
Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client
Proactively manages and coordinates activities to ensure timeliness of deliverables to exceed contractual obligations
Interact with project team members to successfully fulfill contract obligations with the highest quality and in a timely manner meeting PRITM's ISO requirements
Instills integrity throughout the organization via active participation in ISO requirements including but not limited to timely submission of Corrective Action Plans for all matters in which either PRITM standards and/or corporate contract standards have not been met.
Communicating outcomes to team members to ensure a positive, open, environment which mitigates risk and achieves a culture of Continuous Quality Improvement
Contributes to business development efforts for new sales and marketing to promote the business through professional communications, sound decisions and by exceeding all contract timeframes and deliverable requirements
Proven skill and experience in excellent oral and written communication spanning executives to the public
Reviews and applies federal and state law, rules, guidance and operational processes applicable to the IDRE program and No Surprises Act
Must have experience working in health care industry
Experience in analyzing and applying federal and state law, rules, guidance and program policies applicable to health care and dispute resolution
Serves as lead individual for stakeholder communications with ability to diffuse confrontational interactions using data nd facts
Oversees the Engagement Team to ensure that team members utilize critical thinking skills, apply IDRE program policies, state and federal laws and regulatory guidance to adjudicate disputes, complete all case related documentation, and send appropriate email notification per the established workflow
Oversees completion of the IDRE Correspondence log, including daily analysis of the information, and submits the log to Senior Management
Identifies patterns and trends in correspondence data, and works collaboratively with Senior Management to implement corrective action plans and evaluate program performance
Utilizes legal knowledge and project resources for research and reference verification
Demonstrated skill and experience in managing a large workload with varying deliverable dates
Flexible to meet contract performance metrics
Participate in interdisciplinary collaboration with PRITM staff, recognized teaming partners, and/or subcontractors
Demonstrated skill and experience in management and oversight to ensure submission of timely, accurate deliverables
Demonstrated experience and skills in excellent customer service
Interact with government and private sector clients, partners, and PRITM staff in a professional and accountable manner, and as a representative of PRITM
Perform other duties as requested
Requirements:
Juris Doctorate degree
Knowledge of and experience in arbitration, dispute resolution, federal and state law, regulatory guidance and application of policies
Able to communicate in a clear manner when explaining the relationship of applicable laws, guidance and/or regulation to specific disputes throughout the IDRE program and with stakeholders
Excellent written and verbal communication skills
Ability to deal with difficult stakeholders and diffuse confrontational situations
Ability to lead a team to investigate and resolve issues raised
Ability to work collaboratively to meet program goals
Has a thorough understanding of the Federal IDR process, regulations related to the Federal IDR program
Applies Federal IDR regulations and policies, and PRITM policies, when evaluating Disputes and the overall PRITM IDR program
Strong analytical and problem-solving skills with the ability to communicate solutions within the program and to stakeholders
Reliable and trustworthy; Integrity is required
Excellent organizational skills and ability to pay attention to detail
Ability to contribute to and work effectively within a team environment
Ability to interface with management and contract staff personnel
Proficient user of Microsoft office suite such as Outlook, Access, Excel and Word
Ability to be discrete and maintain confidentiality
Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
Must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA)
Ability to obtain and maintain U.S. Government Security Clearance
Preference will be given to qualified individua
