Healthcare IDR Dispute Specialist

IPRO; 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 to determine appropriate reimbursement amounts and ensure submissions comply with federal requirements.

The role requires strong analytical skills, impartial reviews, and clear written determinations.

Qualifications

• Experience with medical billing, auditing, or claims review in healthcare or insurance.
• Excellent communication skills.
• Ability to work independently or in a team.
• Attention to detail in fast-paced environments.

Responsibilities

• Adjudicate IDR cases from assignment to final determination.
• Review submissions and evidence for compliance.
• Analyze factors such as QPA, training, and market data.
• Prepare written determinations with rationale.
• Maintain neutrality and meet IDR timelines.
• Communicate with providers, facilities, and plans.

Skills

Dispute resolution

Analytical thinking

Independent judgment

Education

Associates degree

Bachelor's degree

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 to determine appropriate reimbursement amounts and ensure submissions comply with federal requirements.

The role requires strong analytical skills, impartial reviews, and clear written determinations.