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.

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 opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their 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 recruiting process, please send a request to learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:

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