Peer Reviewer (QA)

Remote - Remote Employees, VA 12345

• Salary Range: $70,000.00 - $90,000.00 Salary
• Position Type: Full Time

About Capitol Bridge  

Founded in 2012, Capitol Bridge is based in Arlington, Virginia and has proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing and eligibility reviews.  Capitol Bridge, LLC is seeking a dynamic and experienced individual to join our team as a Peer Reviewer/Arbitration Quality Analyst.

Benefits Include: 

• Medical, dental, vision, and pharmacy benefits with employer contribution 

• Company-sponsored life insurance 

• 401(k) retirement plan with company match 

• Paid time off 

• Employee Assistance Program 

• Paid training 

• Paid holidays 

Position summary 

Review Arbitration determination letters against approved quality standards, document findings before or after closeout as assigned, and provide feedback and guidance to arbitrators. 

Key responsibilities 

• Perform assigned quality reviews of arbitrator determination letters using applicable policies, templates and project guidance. 

• Assess drafting of determination letters, including documentation of supportive findings in favor of prevailing party with well-written, logical and defensible outcomes that meet Capitol Bridge standards.

• Ensure that arbitrator performed appropriate assessment of the dispute-specific evidence.

• Ensure that arbitrator performed accurate completion of tasks in electronic databases,

• Record clear findings and provide substantive feedback and guidance to arbitrators in a professional tone in the designated system. 

• Identify quality trends and findings and escalate as appropriate.

• Participate in calibration reviews and report recurring defects or unclear standards.

Qualifications

Qualifications 

• Experience with Federal No Surprises Act.

• Experience reviewing complex written case decisions or regulated documentation. 

• Very strong attention to detail and ability to explain findings neutrally and clearly. 

• Education Requirement: A Juris Doctor (J.D.) degree from an accredited law school is required.

Measures of success 

• Accuracy and defensibility of determination letters. Completing assigned audits in timely manner.

• Audits include accurate assessment of determination letters based on thorough review of dispute case files, and the provision of substantive, constructive feedback to arbitrators.

• Active engagement in calibration reviews.

• Report error trends as identified. 

Working relationships 

Works across the assigned lane and with Training, Compliance, Reporting, and Program Leadership as needed. Follows approved decision rights, confidentiality requirements, and escalation paths. 

Screenings Required:

You will receive requests for background check, fair credit check, and drug screen regarding this employment opportunity. Respond to all requests quickly as we anticipate filling our vacancies quickly and non-responses may result in disqualification for this opportunity.

*Please be aware that our organization and our client adhere to stringent security regulations, necessitating a thorough background screening process for all potential hires. We value transparency and want to inform you that this screening may result in a delay of at least 60 days prior to onboarding. Rest assured, we are committed to maintaining a secure and compliant work environment. We appreciate your understanding and cooperation as we prioritize the safety and confidentiality of our operations. 

Reasonable Accommodation:

If you require alternative methods of application or screening, you must approach the employer directly to request this. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

EEO Statement:

Capitol Bridge is an Equal Opportunity Employer. All employment decisions at CB are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.