IDR Resolution Specialist

Global Medical Response; Lewisville (TX); Hybrid; USD 64.000 - 86.000; Vollzeit

Zusammenfassung

Global Medical Response (GMR) in the Dallas area is seeking an IDR Resolution Specialist to support NSA/IDR workflows, manage high‑volume communications with IDREs, and maintain precise case records to ensure timely regulatory compliance.

You will collaborate with Revenue Cycle and Legal teams, handle dispute cancellations, re‑opening requests, and fee reconciliations, and drive data‑driven insights while adhering to strict timelines.

Qualifikationen

• Prior experience in Revenue Cycle, Managed Care, and/or Legal.
• 3–5+ years in legal operations, payer/provider dispute resolution, or related field.
• Experience with NSA, IDR, arbitration, or claims dispute processes.
• Proficiency with case management and collaboration tools (e.g., Appian/CRM, Outlook/Teams, SharePoint).
• Strong legal writing and advocacy skills for formal correspondence to IDREs and CMS.
• Data fluency: interpret and present insights on cancellations, timelines, and payment tracking.

Aufgaben

• Draft, send, and track correspondence with certified IDREs; coordinate status updates and follow-ups.
• Dispute cancellations; evaluate cancellation notices, prepare responses/appeals, and pursue reversals or re-opening requests.
• Manage and reconcile IDR administrative and arbitration fees.
• Classify email manually; apply labels to route items to the correct case, payor, and phase.
• Initiate, reselection, and portal submissions for Federal IDR; monitor timeline compliance.
• Produce reporting on dispute cancellations and related operational/executive metrics; define target cancellation rates.
• Prepare and send formal re-opening requests to CMS when cancellations are issued in error; track responses.
• Validate eligibility and timing and correct party/payor attribution; coordinate reselections.
• Update case management systems.
• Review EOBs and plan information to confirm NSA applicability; document findings when omissions occur.
• Coordinate cross-functionally to resolve data issues and align on dispute strategy.

Kenntnisse

Legal operations

Payer dispute resolution

IDR / NSA knowledge

CMS submissions

Data analysis

Regulatory timelines

English fluency

Ausbildung

High School diploma or equivalent

2 years of post-High School education

Tools

Appian/CRM

Outlook/Teams

SharePoint

Jobbeschreibung

IDR Resolution Specialist

Location: Hybrid (must live within 60 miles of Dallas, TX)

Schedule: Full-Time

Annual Pay: $75,000

Position Summary

The IDR Resolution Specialist supports the No Surprises Act (NSA) legal workflow across Federal Independent Dispute Resolution (IDR), and post‑determination actions. This role manages high‑volume communications with certified Independent Dispute Resolution Entities (IDREs), coordinates closely with Revenue Cycle and Managed Care teams, maintains precise case records (e.g., DISP numbers, payor attribution), and drives timely, compliant execution against strict regulatory timelines.

Key Tasks & Responsibilities

• Draft, send, and track correspondence with certified IDREs; coordinate status updates and follow‑ups.
• Dispute cancellations; evaluate cancellation notices, prepare responses/appeals, and pursue reversals or re‑opening requests.
• Manage and reconcile IDR administrative and arbitration fees.
• Classify email manualy; apply labels to route items to the correct case, payor, and phase.
• Initiate, reselection, and portal submissions for Federal IDR; monitor ONP/IDR timeline compliance and deadline tracking.
• Produce reporting on dispute cancellations and related operational/executive metrics; partner with leaders to define target cancellation rates.
• Prepare and send formal re‑opening requests to CMS when cancellations are issued in error; track responses and elevate as needed.
• Validate eligibility and timing and correct party/payor attribution, coordinate reselections where appropriate.
• Update case management systems.
• Review EOBs and plan information to confirm NSA applicability; document findings where carriers omit required NSA eligibility statements.
• Coordinate cross‑functionally (Legal, Revenue Cycle, Managed Care) to resolve data issues, prepare submissions, and align on dispute strategy.

Qualifications

• Prior experience in Revenue Cycle, Managed Care, and/or Legal
• 3–5+ years in legal operations, payer/provider dispute resolution, or related field
• Experience working with NSA, IDR, arbitration, or claims dispute processes (highly preferred)
• Working knowledge of the No Surprises Act, Federal IDR process, and air ambulance considerations (e.g., COP, reselection, IDRE roles)
• Proficiency with case management and collaboration tools (e.g., Appian/CRM, Outlook/Teams, SharePoint); advanced document control and email triage
• Strong legal writing and advocacy skills for formal correspondence to IDREs and CMS; ability to synthesize regulations and facts quickly
• Data fluency: ability to interpret and present insights on cancellations, win rates, timelines, dispute pathways, and payment tracking to leadership
• Knowledge of claims processing, EOB structures, payor policies, and reimbursement methodologies
• Awareness of common denial reasons, coding basics (CPT/HCPCS/ICD), and provider–payor dispute dynamics
• Must be fluent in English

Skills & Competencies

• Deadline ownership and process rigor across simultaneous disputes
• Analytical problem‑solving; meticulous record‑keeping and audit readiness
• High judgment in interpreting eligibility, timelines, and regulatory nuance
• Understanding of contracted vs. non‑contracted rates, allowed amounts, and payor negotiation practices
• Coordinating with cross‑functional teams in a regulated environment
• Experience with CMS submissions, appeals, or formal regulatory communications is a strong plus
• Experience in a position with direct responsibility for delivery of patient accounting services, healthcare billing and follow-up services
• Strong problem-solving skills, attention to detail, and ability to make timely decisions
• Experience with CMS submissions, appeals, or formal regulatory communications is a strong plus

Education

• High School diploma or equivalent
• 2 years of post-High School education

Why Choose GMR?

Global Medical Response (GMR) and its family of solutions are dedicated to delivering compassionate, quality medical care, primarily in the areas of emergency and patient relocation services. Here you’ll embark on meaningful work that will make an impact on you and the customers we serve. View the stories on how our employees provide care to the world at www.AtaMomentsNotice.com.

GMR’s Core Behaviors

—keep care at the center, raise your hand, seek to understand, find a way together and be accountable—unite our teams and set us apart in emergency medical services.

EEO Statement

Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability.

Check out our careers site benefits page to learn more about our benefit options.