Healthcare IDR Dispute Resolution Specialist

ADP, Inc.; Jericho (NY); On-site; USD 75,000 - 80,000; Full time

Job summary

IPRO is seeking a Dispute Resolution Specialist to independently administer and adjudicate healthcare payment disputes under the No Surprises Act IDR process. You will review disputes between providers, facilities, and health plans and render binding determinations with evidence-based reasoning.

The role requires strong analytical skills, attention to detail, and the ability to work both independently and within multidisciplinary teams in a fast-paced environment in Jericho, NY.

Qualifications

• Experience with healthcare claims and appeals processes.
• Ability to work independently and in teams in a fast-paced setting.
• Strong analytical and problem-solving skills.
• Detail-oriented with excellent organizational abilities.

Responsibilities

• Adjudicate Independent Dispute Resolution (IDR) cases from assignment to final determination.
• Review submissions and evidence for compliance with IDR requirements.
• Assess qualifying payment amounts, prior rates, and other factors per regulations.
• Evaluate medical records and billing documentation to support determinations.
• Research federal statutes, guidance, payer information, and contractual data.
• Prepare clear, written determinations with rationale for payment decisions.
• Maintain impartiality and comply with timelines and IDR procedures.
• Communicate effectively with providers, facilities, and health plans.

Skills

Healthcare claims & appeals

Independent work

Attention to detail

Strong communication

Education

Associate degree with 4 years of experience in medical billing, auditing, or claims review

Bachelor's degree with 3 years of experience in medical billing, auditing or claims review

Tools

CMS Federal IDR Portal

Job description

IPRO is seeking a Dispute Resolution Specialist to independently administer and adjudicate healthcare payment disputes under the No Surprises Act IDR process. You will review disputes between providers, facilities, and health plans and render binding determinations with evidence-based reasoning.

The role requires strong analytical skills, attention to detail, and the ability to work both independently and within multidisciplinary teams in a fast-paced environment in Jericho, NY.