IDR and Appeal Resolution Analyst

Job Description

The IDR and Appeal Resolution Analyst will log, track, and process Federal Indepependent Dispute Resolutions (IDR), appeals and grievances. Set up and maintain case files for grievances and collect the information required by organizational policies and applicable regulations. The IDR and Appeal Resolution Analyst will conduct research and coordination needed to evaluate, process, respond to, and refer or close appeals and IDRs.

Investigates and responds to complaints, grievances, and appeals consistently, adhering to all regulatory, accreditation, and Company processing timelines and guidelines.

• Conducts thorough investigations of all related participant/member, and provider correspondence through a comprehensive fact-finding review to understand all the issues involved.

• Obtains required information from various Company departments and personnel, and external entities, contracted vendors, and state and federal regulatory agencies, delegated entities, Medical Groups and Network Physicians.

Skills and Requirements

• Minimum of 3 years of related experience managing healthcare claims, billing disputes, and compliance under regulations like the No Surprises Act.

• Knowledge of Federal IDR, appeals and grievance processes, procedures and operations as in a healthcare setting.

• Knowledge of problem resolution principles, HIPAA/ PHI safeguards and other applicable regulations and requirements in a healthcare setting.

• Strong written and verbal communication skills and problem-solving techniques.

• Third party administration experience

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].