Reliant Health Partners · 2 months ago
NSA IDR Dispute Specialist
United States
Full-time
Remote
Entry, Mid Level
$50K/yr - $60K/yr
2+ years expReliant Health Partners is an innovative medical claims repricing service provider, helping employers achieve maximum health plan savings with minimum noise. As an IDR dispute specialist, you are responsible for managing all IDR disputes, documenting the process, and communicating with various teams to ensure timely resolution of disputes.
Health CareHealth InsuranceInsuranceMedical
Responsibilities
Monitor, manage and add appeals to the queue
Monitor and manage all IDR emails from CMS, initiating provider, finance, compliance team and client
Research and communicate via CMS portal for the initial dispute within 3 business days from the received date
Research and communicate with the finance team for IDRe/admin payment within 3-5 business from the received date
Research and communicate with the compliance team to request an offer & supporting documents for the IDRe within 3-5 days business days from the received date
Document & upload IDR documents in queue
Compile folders for individual disputes to catalog documents and prep for offer & supporting documents from our compliance team
Communicate IDR rulings with NSA Manager & compliance team
Process IDR rulings and if needed, send adjustment to the client
Document all IDR processes in manual. Highlight special scenarios and maintain examples for complex disputes and or rulings
Maintain acceptable levels of production including but limited to turn around time standards as mandated by the regulation(s)
Adhere to client specific and Reliant protocols, scripts, and other requirements
Perform other job-related duties and special projects as required
Other duties as assigned
Qualification
Required
2-3 years of relevant job experience – No Surprises Act, negotiations and or medical claim processing
Experience conducting outreach to clients & providers via email or other means of communication
Experience understanding company critical behaviors and compliance requirements
Broad healthcare policy and payment understanding
Experience with claims workflow tools or systems
Benefits
Comprehensive medical, dental, vision, and life insurance coverage
401(k) retirement plan with employer match
Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
Paid time off (PTO) and disability leave
Employee Assistance Program (EAP)
Company
Reliant Health Partners
Reliant Health Partners is a medical cost containment and specialty bill review company.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
D
Douglas Farquhar
VP of Strategy
Company data provided by crunchbase