Essential Duties and Responsibilities:

- Provide advice, leadership and guidance to ensure appropriate determination of eligibility and processing of informal resolution.

- Guide the hearing, adjudication, complex or integrated teams to ensure all major requirements are met and relevant documents for appellant and hearing officer are captured accurately and according to Federal law and client requirements.

- Provide self-directed legal support to the project leadership.

- Provide direction, leadership, and training to production personnel on case management and case processing.

- Process and resolve high profile and complex appeals.

- Analyze projects, present data collection reporting and analysis management to client.

- Provide legal research and assistance for CMS/MAG on ACA regulations and appeal adjudications.

- Perform other duties as assigned by management.

- Arbitration Support: provide consultative support to the arbitration team, helping them navigate regulatory requirements, ensuring that dispute resolution is carried out in accordance with established guidelines, and assisting in the interpretation of IDR rulings.

- Policy Development & Maintenance: develop, review, and update policies and procedures related to the IDR process to ensure compliance with the No Surprises Act and other federal and state regulations.

- Documentation: maintain thorough documentation of all processes, policies and revisions.

- Training & Communication: develop and deliver training materials and communications to staff and stakeholders regarding policy updates, regulatory changes and procedural expectations for the IDR process.

- Collaboration: support and work closely with Payment Determination Manager, Training, Quality Assurance, and operations teams to ensure IDR process is operating effectively.

- Arbitration: Render payment determinations as needed by the business. Process and resolve high profile and complex cases. 

Minimum Requirements

- Bachelor's degree with 5-7 years of experience consulting within designated function.

- Advanced degree preferred.

- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.

- Ensure solutions are consistent with organization objectives.

- Solutions may serve as precedent for future decisions.

- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.

- Develop new applications based on professional principles and theories.

- Viewed as expert in field within the organization.

- Juris Doctor (JD) from an accredited law school and/or legal background and experience highly preferred.- Knowledge and/or experience working with the Federal No Surprises Act preferred.- Experience developing policies and procedures preferred. - Ability to work a schedule of 8:00am - 4:30pm EST Monday - Friday required.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)- Minimum 5mpbs upload speed- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router- Private work area and adequate power source- Must currently and permanently reside in the Continental US EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.