MagnaCare is seeking experienced Provider Compliance Associates skilled in investigating and resolving disputes from providers related to the No Surprises Act to ensure compliance.
Primary Responsibilities
Support all aspects of the No Surprises Act to remain compliant.
Prepare cases and all pertinent electronic documentation during the Open Negotiation period.
Prepare cases and all pertinent electronic documentation during the IDR period.
Perform advanced claim processing research, such professional, facility, and ancillary claims, including application of medical policy and procedures.
Perform advanced provider contract research and rate-negotiation communications.
Communicate effectively with interdepartmental teams.
Maintain tracking system for all Open Negotiation and IDR requests.
Contribute ideas on ways to resolve problems to better serve the customer and/or improve productivity.
Solve unstructured problems that may require reliance on conceptual thinking.
Essential Qualifications
Bachelor's degree or equivalent work experience, preferably in healthcare.
Extensive knowledge of the No Surprises Act.
Strong knowledge of medical coding systems—including CPT Codes, HCPCS Codes, ICD-10 Codes, and Modifiers—to assist in claims-related inquiries.
Strong knowledge and experience of healthcare claims processing, both professional and facility.
Knowledge and experience of healthcare provider contract negotiations is required.
Ability to meet expected production standards and government-mandated timeframes.
Strong knowledge of provider contracts, medical terminology, payment policies and procedures, and claims processing.
Advanced analytic abilities.
Excellent written and oral communication skills.
Interpersonal and negotiation skills, with a demonstrated ability to prioritize tasks as required.
Proficient in Microsoft Office (Word and Excel).
At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect, and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
For more than 30 years, MagnaCare LLC has been a trusted partner in delivering flexible, customized solutions for self-insured organizations. As a national third-party administrator (TPA), we combine proprietary technology, network expertise, and a deep understanding of labor to help our clients achieve their goals while supporting the people they serve.
Our focus on labor means we work closely with funds, Taft-Hartley Trusts, and other self-insured groups to deliver tailored solutions that go beyond the basics. From health plan administration and eligibility management to contribution accounting, we provide the tools and support organizations need to succeed. With specialized offerings such as flexible network administration, direct contracting, in-house medical and care management, and workers’ compensation programs, we create benefit plans that address unique needs with precision.
