Temporary No Surprises Act (NSA) Operations Specialist

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At BCBSRI our greatest resource is our people.

We come from varying backgrounds different cultures and unique experiences. We are hard-working caring and creative individuals who collaborate support one another and grow together. Passion empathy and understanding are at the forefront of everything we donot just for our members but for our employees as well.

We recognize that to do your best work you have to be your best self.
Its why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health dental and vision insurance as well as programs that support your mental health and well-being. We pay competitively offer bonuses and investment plans and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where youre at in the organization youre an integral part of our team and your input thoughts and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

Were dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality affordable and equitable care. To further improve the health and well-being of our fellow Rhode Islanders we regularly roll up our sleeves and get to work (literally) in communities all across the statebuilding homes working in food pantries revitalizing community centers and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can our associates receive additional paid time to volunteer.

Why this job matters:

This temporary role provides operational support for No Surprises Act (NSA) processes including open negotiation and independent dispute resolution activities. The role focuses on case tracking documentation and coordination to ensure timely and accurate processing during periods of increased volume.

What you will do:

• Support NSA-related activities for Network Contracting.
• Maintain documentation and continuous tracking of cases specific to negotiations and offers for the Open Negotiation Notification and Independent Dispute Resolution (IDR) intake processes.

Open Negotiation Notification (ONN)

• Review and prepare offers during the open negotiation period.

Independent Dispute Resolution (IDR)

• Prepare dispute documentation (e.g. Qualifying Payment Amount rationale)
• Work in collaboration with administrative staff to ensure IDR payments are submitted timely
• Work cross-functionally with GAU and Operations teams
• Identify cases that may not qualify and escalate for review
• Analyze dispute determinations
• Track key metrics (IDR volume outcomes turnaround time financial impact)
• Compile data and assist in reporting and analysis

What you need to succeed:

• Two to four years of experience in health plan operations
• Strong analytical organizational operational and communication skills
• Ability to manage multiple priorities in a fast-paced regulatory environment
• Ability to organize work efficiently to meet established time and quality standards
• Proficient in Excel

The extras:

• Bachelors degree in Healthcare Administration Business Public Health or related field
• Direct experience with the No Surprises Act IDR or out-of-network reimbursement
• Proficient in Outlook

Location:
BCBSRI is headquartered in downtown Providence conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states pending approval from the Human Resources Department: Arizona Connecticut Florida Georgia Louisiana Massachusetts North Carolina Oklahoma Rhode Island South Carolina Texas Virginia
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do and it strengthens our ability to meet the challenges of todays healthcare industry. BCBSRI is an equal opportunity employer.

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