IDRE QA Specialist — Remote, Impactful & Compliant

North Haven Solutions; EE. UU.; Híbrido; USD 65.000 - 95.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

401k with company match

Remote workspace equipment stipend

Paid time off

Voluntary life insurance options

Other voluntary benefits

Descripción de la vacante

North Haven Government Services Solutions is seeking an IDRE QA Specialist to join our Operations team. This role ensures accuracy, completeness, and timely delivery of CMS reports within the IDR process.

The QA Specialist coordinates with customers, reviewers, and management to resolve questions and deficiencies while upholding HIPAA/PHI protections. The ideal candidate is highly organized, detail-oriented, and capable of managing multiple priorities in a deadline-driven environment.

Formación

• An LPN, Associate’s or Bachelor’s degree is preferred; relevant professional experience may be considered.
• Business experience in healthcare and/or insurance settings is preferred.

Responsabilidades

• Review reviewer reports for accuracy, completeness, and adherence to customer requirements, company standards, and applicable clinical guidelines.
• Coordinate and communicate effectively with customers, reviewers, and management to resolve questions, address deficiencies, and facilitate timely report completion.
• Ensure reports meet established quality standards and are submitted to CMS within required deadlines.
• Identify discrepancies, missing information, and opportunities for improvement throughout the review process.
• Maintain a strong understanding of company processes, quality expectations, and applicable IDRE requirements.
• Contribute to continuous process improvement initiatives designed to enhance quality, efficiency, and turnaround times.
• Work collaboratively with the Operations team to support the company’s continued growth and operational success
• Evaluates the Quality of the dispute rationale/ determination to ensure that all requirements have been met in compliance with internal and CMS guidelines.
• Follow up with the arbiters for any pertinent and missing information
• Assess whether the rationale is logical and the conclusions are based on sound assumptions
• Maintain professionalism and courtesy when responding to emails and other communications, while ensuring all communications involving HIPAA and PHI are handled appropriately, securely, and in accordance with applicable privacy and confidentiality requirements.

Conocimientos

Detail-oriented

Strong communication skills

Deadline-driven

Problem-solving abilities

Accuracy-focused

HIPAA and PHI handling

Educación

LPN

Associate’s degree

Bachelor’s degree

Descripción del empleo

North Haven Government Services Solutions is seeking an IDRE QA Specialist to join our Operations team. This role ensures accuracy, completeness, and timely delivery of CMS reports within the IDR process.

The QA Specialist coordinates with customers, reviewers, and management to resolve questions and deficiencies while upholding HIPAA/PHI protections. The ideal candidate is highly organized, detail-oriented, and capable of managing multiple priorities in a deadline-driven environment.