Healthcare IDR Dispute Specialist

ISLAND PEER REVIEW ORGANIZATION INC; Jericho (NY); Sur place; USD 75 000 - 80 000; Plein temps

Résumé du poste

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

The role requires strong analytical skills, independent judgment, and the ability to communicate findings clearly while adhering to federal IDR requirements and timelines.

Qualifications

• Familiarity with healthcare claims and appeals processes is required.
• Ability to interact with healthcare providers and commercial payors.
• Strong independent work habits and teamwork as needed.
• Attention to detail in a fast-paced setting.

Responsabilités

• Adjudicate Independent Dispute Resolution (IDR) cases from assignment to final determination.
• Review submissions and evidence for compliance with IDR requirements.
• Analyze factors affecting reimbursement amounts.
• Evaluate clinical and billing documentation for evidence-based determinations.
• Research regulatory information to support decisions.
• Prepare clear written determinations with rationale.
• Maintain neutrality and meet timelines.
• Communicate with clients, providers, and internal teams.

Connaissances

Healthcare claims & appeals processes

Independent work / teamwork

Attention to detail

Fast-paced environment adaptability

Formation

Associate degree + 4 years experience

Bachelor's degree + 3 years experience

Outils

Electronic Health Records (EHR) familiarity

Healthcare claims data familiarity

Description du poste

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

The role requires strong analytical skills, independent judgment, and the ability to communicate findings clearly while adhering to federal IDR requirements and timelines.