Independent Dispute Resolution - Independent Dispute Resolution, Claims/OON Specialist

Job Summary: We are seeking an experienced and highly motivated Independent Dispute Resolution (IDR) Claims / OON Specialist to join our team. This role requires expertise in medical billing, collection, and appeals and a strong understanding of dispute resolution processes. The ideal candidate will be responsible for managing and resolving medical billing disputes efficiently and in compliance with regulatory requirements.

The Independent Dispute Resolution (IDR) Claims / OON Representative needs to assist in managing claims disputes under the No Surprises Act. This position requires an in-depth understanding of healthcare billing, regulations, and dispute resolution processes, ensuring compliance with the No Surprises Act and protecting patients from surprise medical bills.

As an IDR Representative, you will be responsible for managing disputes between healthcare providers and insurers, determining the appropriate payment amounts for out-of-network services, and working to resolve disputes efficiently and effectively. This is a key role in helping ensure fair and transparent billing practices by federal regulations.

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Job Responsibilities/Duties:

· Review and resolve medical billing, collection, and appeals disputes.

· Work with insurance companies, medical providers, and other stakeholders to resolve claims.

· Ensure compliance with all federal and state regulations in dispute resolution.

· Communicate effectively with all parties to facilitate the resolution of claims.

· Maintain accurate documentation of dispute resolution processes and outcomes.

· Prepare and submit required reports and documentation promptly.

· Proven experience with medical billing, collections, and appeals processes.

· Strong understanding of medical billing codes and regulations.

· Excellent communication and negotiation skills.

· Strong attention to detail and organizational abilities.

· Ability to work independently and as part of a team.

· Ability to handle complex and sensitive information with confidentiality and professionalism.

Qualifications & Experience:

· Experience with State or Federal Independent Dispute Resolution processes (e.g., TDI, NSA).

· Familiarity with industry regulations and dispute resolution protocols.

· Proficiency with medical coding, billing systems, and healthcare software.

EDUCATION / EXPERIENCE

· High School Diploma or equivalent required.

· Associate’s or Bachelor’s degree in healthcare administration, business, or related field is preferred.

· Minimum of 3 years of experience in medical billing, collections, and appeals.

· Demonstrated experience in dispute resolution, preferably in a healthcare setting.

PHYSICAL DEMANDS

· Requires visual acuity to inspect and analyze work close to the eyes and ability to hear sound with or without correction; Ability to climb, stoop, kneel, reach, stand, walk pull, push lift, and able to exert up to 40 pounds of force occasionally and/or up to 10 pounds of force constantly to move objects.

· Moderate physical activity, performing somewhat strenuous daily activities of a primarily administrative nature.

· The physical demands for this position include adequate vision, hearing, and repetitive motion.

· Ascending or descending stairs, ramps, and the like, using feet and legs and/or hands and arms.

· Substantial movements (motion) of the wrist, hands, and/or fingers in a repetitive manner - Bending legs downward and forward by bending leg and spine - Standing, particularly for sustained periods of time.

Using upper extremities to exert force to draw, drag, haul or tug objects in a sustained motion.

· Raising objects from a lower to a higher position or moving object horizontally from position to position

WORK CONDITIONS

• While performing the duties of this job, the employee is frequently required to stand, walk, sit, reach with hands and arms, and talk or hear.

• The employee is occasionally required to stoop, kneel, crouch, or crawl and taste or smell.

• The employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures, transcribing, and viewing a computer terminal.