IDR Compliance Specialist

Capitol Bridge, LLC.; Virginia; On-site; USD 70,000 - 95,000; Full time

Job summary

Capitol Bridge is seeking an IDR Compliance Specialist to support the No Surprises Act compliance program. You will review eligibility determinations, arbitration decisions, and case files to ensure alignment with statute, regulation, CMS guidance, and internal standards.

You will apply established policies, draft and maintain procedures, and collaborate across teams to communicate guidance. A JD or compliance cert plus 2+ years in healthcare compliance is preferred.

Qualifications

• Bachelor’s degree required; JD, paralegal certificate, or compliance cert preferred.
• 2+ years of experience in healthcare compliance or regulated settings.
• Ability to read, interpret, and apply regulatory guidance to real cases.
• Proficiency with case management systems and Microsoft Office, especially Excel.

Responsibilities

• Conduct compliance reviews of eligibility determinations, arbitration decisions, and case files.
• Apply policies to day-to-day IDR work and escalate complex questions to management.
• Draft and maintain policies, procedures, and job aids translating regulatory requirements.
• Document issues, collect info for root-cause analysis, and track corrective actions.
• Monitor CMS guidance and regulatory updates; summarize changes for leadership.
• Assist with audits and CMS oversight activities, gathering documentation.

Skills

Attention to detail

Communication

Regulatory interpretation

Project management

Education

Bachelor's degree

Juris Doctor (JD)

Paralegal certificate

CCEP

CHC

Tools

Microsoft Office

Excel

Case management systems

Job description

IDR Compliance SpecialistAbout Capitol BridgeFounded in 2012, Capitol Bridge is based in Arlington, Virginia and has proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing and eligibility reviews. Capitol Bridge, LLC is seeking a dynamic and experienced individual to join our team as an IDR Compliance Specialist.Role OverviewThe IDR Compliance Specialist supports the legal and operational compliance function of an established and growing federal Independent Dispute Resolution Entity (IDRE) supporting the No Surprises Act. Reporting to the Senior Manager, IDR Compliance, this role carries out the day-to-day compliance activities that keep eligibility determinations, arbitration decisions, and case handling practices aligned with federal requirements, CMS guidance, and internal standards. The ideal candidate is detail oriented, comfortable working with complex regulatory material, and brings experience in healthcare compliance, dispute resolution, or a similarly regulated environment. Direct exposure to the federal IDRE process is a strong plus.Key ResponsibilitiesConduct compliance reviews of eligibility determinations, arbitration decisions, and case files to confirm alignment with statute, regulation, sub regulatory guidance, CMS policies, and internal standards.Apply established policies and operational standards to day-to-day IDR work, escalating novel, complex, or ambiguous questions to the Senior Manager, IDR Compliance.Assist in drafting and maintaining policies, procedures, desk guides, and job aids that translate regulatory requirements into clear operational instructions.Support the organization’s quality and compliance framework by documenting identified issues, gathering information for root cause analysis, and tracking corrective actions through completion.Track and analyze compliance and quality data to identify trends, recurring errors, or process gaps, and prepare summaries and reports for compliance leadership.Collaborate with operational, training, and quality teams to communicate guidance updates and help develop targeted training content and reference materials.Monitor Federal Register publications, CMS guidance, litigation developments, and industry updates, summarizing relevant changes and flagging potential operational impact for leadership review.Assist with internal and external audits, CMS oversight activities, and other compliance reviews, including gathering documentation, maintaining audit ready records, and drafting initial written responses for review.Serve as a resource for operational staff on routine eligibility, procedural, and documentation questions, applying approved guidance consistently.QualificationsBachelor’s degree required; Juris Doctor (JD), paralegal certificate, or compliance certification (such as CHC or CCEP) preferred.2+ years of experience in healthcare compliance, regulatory affairs, legal operations, payment dispute resolution, or related regulated settings.Working knowledge of federal healthcare regulation, with familiarity with the No Surprises Act and the federal IDR process is strongly preferred.Demonstrated ability to read, interpret, and apply regulatory and policy guidance to real case scenarios.Strong attention to detail and organizational skills, with the ability to manage a high volume of reviews and deadlines accurately.Clear written and verbal communication skills, including the ability to summarize regulatory content for nonlegal audiences.Proficiency with case management systems and Microsoft Office, particularly Excel for data tracking and reporting.Preferred AttributesPrior experience supporting compliance, eligibility, or arbitration work at an existing IDRE or comparable federal dispute resolution program.Comfort working in a fast-evolving program environment and adapting quickly to new or updated regulatory guidance.Practical, collaborative approach that values accuracy, consistency, and sound judgment about when to escalate.Screenings Required:You will receive requests for background check, fair credit check, and drug screen regarding this employment opportunity. Respond to all requests quickly as we anticipate filling our vacancies quickly and non-responses may result in disqualification for this opportunity.*Please be aware that our organization and our client adhere to stringent security regulations, necessitating a thorough background screening process for all potential hires. We value transparency and want to inform you that this screening may result in a delay of at least 60 days prior to onboarding. Rest assured, we are committed to maintaining a secure and compliant work environment. We appreciate your understanding and cooperation as we prioritize the safety and confidentiality of our operations.Reasonable Accommodation:If you require alternative methods of application or screening, you must approach the employer directly to request this. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.EEO Statement:Capitol Bridge is an Equal Opportunity Employer. All employment decisions at CB are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.