Federal IDR Claims Specialist

Gryphon-Healthcare; Houston (TX); On-site; USD 52,000 - 76,000; Full time

Job summary

Gryphon Healthcare is seeking an IDR Claim Specialist to analyze and organize documentation for eligible claims filed with Federal IDR, aiming to resolve billing disputes involving out-of-network providers, facilities, and health plans.

The role includes managing arbitration/mediation processes, preparing documentation packets, and tracking case information in Smartsheets and MS Office tools, while upholding HIPAA confidentiality and delivering strong customer service.

Qualifications

• High School graduate or equivalent required.
• Previous experience in medical billing preferred.
• Ability to interpret Eligibility of Benefits (EOB).
• Maintains confidentiality of patient data per HIPAA.

Responsibilities

• Work daily reports to identify claims eligible for Mediation/Arbitration by insurance type, dates, and EOB dates.
• Prepare Arbitration/Mediation documentation packets for IDR filing, review for accuracy and upload to drive/system.
• Record and track case information via Smartsheets, Excel, Word.
• Identify and communicate IDR trends with Director of Revenue Cycle Management & Legal Team.
• Participate in team meetings and support Legal Team goals and timelines.
• Maintain confidentiality of patient data in compliance with HIPAA.
• Provide support to billing and auxiliary departments as needed.
• Demonstrate good customer service with internal and external customers.

Skills

Attention to Detail

Teamwork

Oral/Written Communication

Computer Skills

Time Management

Professionalism

Ethics and Integrity

Education

High School graduate

Tools

Centricity

Smartsheets

Microsoft Office Suite

Job description

Gryphon Healthcare is seeking an IDR Claim Specialist to analyze and organize documentation for eligible claims filed with Federal IDR, aiming to resolve billing disputes involving out-of-network providers, facilities, and health plans.

The role includes managing arbitration/mediation processes, preparing documentation packets, and tracking case information in Smartsheets and MS Office tools, while upholding HIPAA confidentiality and delivering strong customer service.