IDR Analyst

This is a fully remote position, open to applicants in California.

📋 Description

• Assess dispute eligibility in accordance with federal IDR criteria prior to filing.

• Manage submissions via the CMS portal, which includes documentation, offer amounts, and supporting briefs.

• Track deadlines for ongoing disputes to avoid procedural oversights.

• Handle communications with payers and IDR entities, ensuring follow-ups are monitored until resolution.

• Confirm cases are closed appropriately, identifying any premature or overlooked closures.

• Analyze 835 remittance files and EOBs to reconstruct payer actions and justifications.

• Transform recurring patterns into specifications, checklists, or prompts.

• Leverage AI tools to automate repetitive tasks, collaborating with engineering to ensure lasting improvements.

• Report directly to the Head of Operations while overseeing the daily management of IDR disputes.

⛳️ Requirements

• 2 to 4 years of experience in revenue cycle management, claims operations, denials, appeals, or medical billing.

• Proficient in interpreting EOBs, 835 remittance files, CPT codes, and claim adjustment reason codes.

• Practical experience with AI tools (such as Claude, ChatGPT, or similar) that have been utilized to enhance or expedite real work.

• Comfortable with data and analytical tools, including Excel or Sheets at a pivot-table level; familiarity with SQL is advantageous.

• Strong written communication skills.

• Capable of managing competing deadlines effectively without oversight.

• Preference for working in small teams and navigating the dynamics of early-stage environments over established organizational structures.

• Demonstrated sound judgment, operational insight, and a sense of ownership.

• Direct experience with Independent Dispute Resolution, the No Surprises Act, arbitration, or out-of-network claims is a significant advantage, although not mandatory.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance plans.

• Opportunities for professional development and continued education.

• Flexible working hours and remote work options.

• Collaborative and dynamic work environment.