IDR Analyst – Federal and State

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

📋 Description

• Assess eligibility for disputes and documentation: Examine claim details to confirm that cases satisfy federal Independent Dispute Resolution (IDR) or specific state dispute criteria prior to submission.

• Investigate and interpret state regulatory requirements: For state-specific assignments, autonomously research state regulations, agency guidelines, payer demands, and arbitration processes; interpret their operational implications; and convert that research into clear, dependable instructions and workflows for the team.

• Manage inbox and correspondence review: Oversee shared inboxes and respond to incoming communications from payors and IDR entities, tracking follow-ups and subsequent steps for each case.

• Ensure disputes are accurately closed: Verify that disputes are only closed when they are genuinely resolved, preventing premature or missed closures that could impact reimbursement.

• Track arbitration timelines and correspondence: Monitor deadlines and evaluate communications from health plans, arbitration entities, and internal teams to ensure appropriate case progression.

• Maintain operational tracking and documentation: Update internal systems and spreadsheets to ensure accurate case records, dispute statuses, and operational metrics.

• Facilitate operational enhancements: Assist in refining workflows and documentation as the team develops more scalable dispute management processes, and highlight documentation or system issues to our analytics and product teams when case files are incomplete or inaccurate.

⛳️ Requirements

• 2–4 years of experience in revenue cycle operations, claims management, or reimbursement/insurance operations.

• Background in medical billing or coding; proficient in interpreting Explanation of Benefits (EOBs), claims, and reimbursement codes.

• Proficient in Excel or Google Sheets, including the ability to create and utilize pivot tables for tracking cases and data.

• Exceptional attention to detail and analytical skills; capable of reviewing documentation, identifying inconsistencies, and determining next steps.

• Ability to handle a high volume of competing deadlines with strong written communication skills.

• Comfortable exercising judgment and posing insightful questions instead of waiting for each subsequent step to be outlined; capable of making well-supported recommendations and evolving into greater independent oversight of daily tasks.

🏝️ Benefits

• Competitive compensation, including equity.

• Comprehensive health, dental, and vision insurance coverage.

• Retirement savings plan through a 401(k).

• Flexible time off policies.

• Opportunities for company-wide connection and events.