No Surprises Act Dispute Analyst - Healthcare Payments

Xtalks; Jericho (NY); On-site; USD 75,000 - 80,000; Full time

Job summary

IPRO is seeking a Dispute Resolution Specialist to independently administer healthcare payment disputes under the No Surprises Act IDR process. You will review disputes between providers, facilities, and health plans to determine reimbursement amounts, offering parties to submit evidence, and render binding determinations.

This role requires acute analytical thinking and the ability to perform complex reviews under minimal supervision while ensuring timely, neutral decisions and clear written

Qualifications

• Familiarity with healthcare claims and appeals processes.
• Excellent communication skills.
• Ability to interact with providers and commercial payors.
• Works well independently or in a team.
• Strong attention to detail in fast-paced environments.

Responsibilities

• Adjudicate IDR cases from assignment to final determination.
• Review submissions and evidence for IDR compliance.
• Analyze factors such as QPA, training and experience, and market considerations.
• Review medical records and billing documentation to support payment determinations.
• Interpret regulatory and contractual information to support decisions.
• Prepare clear, written determinations with rationale and ensure timeliness.
• Communicate with clients, providers, and internal teams to resolve issues.

Skills

Healthcare claims

Communication skills

Provider & payer interaction

Independent / team work

Attention to detail

Education

Associates degree with 4 years experience

Bachelor's degree with 3 years experience

Job description

IPRO is seeking a Dispute Resolution Specialist to independently administer healthcare payment disputes under the No Surprises Act IDR process. You will review disputes between providers, facilities, and health plans to determine reimbursement amounts, offering parties to submit evidence, and render binding determinations.

This role requires acute analytical thinking and the ability to perform complex reviews under minimal supervision while ensuring timely, neutral decisions and clear written