No Surprises Act

Position Summary

The No Surprises Act Analyst will support compliance and operational functions related to the federal No Surprises Act (NSA) for Tres Health, a third-party administrator for self-funded group health plans. This role is responsible for monitoring, analyzing, and implementing regulatory requirements, ensuring processes meet federal standards, and serving as a subject matter expert to internal teams, clients, and vendors. The NSA Analyst will assist with reporting, data analysis, negotiations, dispute resolution processes, and the development of policies and procedures that align with evolving regulations.

Key Responsibilities

• Monitor, interpret, and maintain up-to-date knowledge of the No Surprises Act, related CMS/Department of Labor guidance, and other applicable federal and state regulations.
• Support the development and implementation of policies, procedures, and workflows to ensure compliance with NSA requirements (e.g., balance billing protections, transparency requirements, Independent Dispute Resolution (IDR) processes.
• Review provider disputes for NSA applicability and coordinate with claims, provider relations, customer service and legal departments.
• Assist in administering the IDR process, including document preparation, submissions, and tracking outcomes.
• Maintain compliance reporting, dashboards, and metrics to support internal audits and client requests.
• Partner with IT/data teams to validate accurate capture and reporting of NSA-related data.
• Provide training and guidance to internal teams, clients, and external stakeholders on NSA requirements.
• Respond to client inquiries, audits, and regulatory requests related to NSA compliance.
• Conduct periodic internal audits to assess process effectiveness and identify areas for improvement.
• Collaborate with different departments to resolve NSA-related issues.

Education and Experience

A Bachelor's degree in Health Administration, Business, Compliance, or a closely related discipline or the equivalent years of experience or education. (TPA or health plan experience strongly preferred). Familiarity with the No Surprises Act, ERISA, and other healthcare regulations is required.

Knowledge, Skills & Abilities

• Strong understanding of health plan operations, medical claims processing, and provider billing.
• Excellent analytical, problem-solving, and research skills.
• High attention to detail with the ability to interpret and apply complex regulations.
• Strong communication skills (written and verbal) for both internal and client-facing interactions.
• Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and claims/benefits administration systems.
• Ability to manage multiple priorities in a deadline-driven environment.