Remote Dispute Resolution Analyst I – Health Claims

J29, Inc; United States; Remote; USD 22,000 - 25,000; Full time

Job summary

J29, Inc. is seeking a Dispute Resolution Analyst to support the IDR program, handling re-determination files, dispute resolution decisions, and related documentation in a remote healthcare environment.

The role requires attention to detail, the ability to analyze medical vs non-medical cases, and experience with CMS guidelines. You will collaborate with reviewers and external entities while maintaining compliance and accuracy.

Qualifications

• 1 year of experience with provider disputes or claims.
• 1 year of interaction with claims with larger insurance plans.
• 1 year of general office or administrative experience.
• Experience directly relevant to the specific task order or project, preferred.

Responsibilities

• Coordinate delivery of re-determination files and dispute resolution documents between external entities.
• Build reconsideration/dispute resolution case files from evidence submitted and received.
• Analyze case type, appeal categories, and validity of requests per CMS or customer requirements.
• Input data for reconsiderations/dispute resolution into required systems.
• Respond to reconsideration/dispute review requests from appellants, patients, or providers.
• Route or respond to inquiries from appellants/patients regarding reconsiderations/dispute resolution processes.
• Identify suspected fraud or abuse and inform management.
• Stay updated on changes in regulations, policies and procedures.
• Submit requests for re-determination files and ALJ decisions to relevant entities.
• Participate in special projects and perform other duties as assigned.

Skills

Provider disputes

Claims interaction

Administrative tasks

Education

High School Diploma or equivalent

Job description

J29, Inc. is seeking a Dispute Resolution Analyst to support the IDR program, handling re-determination files, dispute resolution decisions, and related documentation in a remote healthcare environment.

The role requires attention to detail, the ability to analyze medical vs non-medical cases, and experience with CMS guidelines. You will collaborate with reviewers and external entities while maintaining compliance and accuracy.