IDR and Appeal Resolution Analyst

Required Skills & Experience
• Minimum of 3 years of related experience managing healthcare claims, billing disputes, nand compliance under regulations like the No Surprises Act. n• Knowledge of Federal IDR, appeals and grievance processes, procedures and noperationsnas in a healthcare setting. n• Knowledge of problem resolution principles, HIPAA/ PHI safeguards and other napplicable regulations and requirements in a healthcare setting. n• Strong written and verbal communication skills and problem-solving techniques.
Nice to Have Skills & Experience
• Third party administration experience
Job Description
The IDR and Appeal Resolution Analyst will log, track, and process Federal nIndepependent Dispute Resolutions (IDR), appeals and grievances. Set up and maintain case nfiles for grievances and collect the information required by organizational policies and napplicable regulations. The IDR and Appeal Resolution Analyst will conduct research and ncoordination needed to evaluate, process, respond to, and refer or close appeals and IDRs. nn Investigates and responds to complaints, grievances, and appeals consistently, nadhering to all regulatory, accreditation, and Company processing timelines and nguidelines. n• Conducts thorough investigations of all related participant/member, and provider ncorrespondence through a comprehensive fact-finding review to understand all the nissues involved. n• Obtains required information from various Company departments and personnel, and nexternal entities, contracted vendors, and state and federal regulatory agencies, ndelegated entities, Medical Groups and Network Physicians.