Project Specialist - Healthcare (remote)

Join The iMPROve Health Team

Come join the iMPROve Health team! iMPROve Health is Michigan's Medicare-designated Quality Improvement Organization. We are both a Cool Place to Work (Crain's Detroit Business) for the last 4 years and one of the Best Places to Work in Healthcare as judged by Modern Healthcare. As a nonprofit organization, we have more than 35 years' experience improving healthcare across the continuum of care using evidence-based and data-driven logic. iMPROve Health provides medical consulting and review, as well as data analysis to federal agencies, state Medicaid and public health organizations, healthcare facilities, private health plans and other third-party payers. We also have extensive experience completing thoughtful and impartial utilization review, dispute resolution and peer reviews. Our goal is simple to help healthcare get better!

This position is 100% remote and provides the opportunity to work virtually with team members from anywhere within the United States. We pride ourselves on providing a great work / life balance for employees, while also providing the ability to promote their career development and gain new skills through employee education opportunities. iMPROve Health offers a wonderful benefit package that includes medical, dental, vision, life insurance, short term and long-term disability, and a generous 401k match.

iMPROve Health is committed to improving the quality, safety, and efficiency of healthcare. Although we do not see patients, we are healthcare professionals (including physicians and nurses) and consultants who work with healthcare providers to promote the adoption and use of evidence-based best practices and processes to achieve our healthcare quality goals. Our services offer our clients and partners access to a proven, impartial, connected resource that understands the intricacies of healthcare. It is our #1 priority to provide thoughtful evidence-based strategies and solutions that help them achieve their healthcare quality improvement goals and outcomes.

EOE / VET / Disability

Must be able to work M-F normal business hours in EST.

Summary :

The Project Specialist assists with the daily workflow administrative responsibilities that support the Federal Independent Dispute Resolution Entity (IDRE) review process. The Project Specialist aids in facilitating the processing of IDR reviews and completes other duties as assigned under the direction of the IDR / IIDR Director and Program Manager. The specialist will work closely with the IDRE team and all reviewers to ensure case timeliness. Responsibilities also includes working with external customers to ensure receipt of all necessary review documentation.

Duties And Responsibilities :

• Assist the team with facilitating review requests in a timely and efficient manner, including implementing processes to track and monitor individual case progress and timeliness.
• Collaborate with IDRE team members to achieve department goals, including prescreening IDR (Independent Dispute Resolution) cases for eligibility using defined criteria.
• Apply knowledge and experience in claims, appeals, and denials to support review and resolution processes, ensuring accuracy, compliance, and timeliness.
• Coordinate, document, and track pertinent data to meet team informational and reporting needs via various applications, including specific review and claims-related portals.
• Work closely with the administrative assistant to ensure receipt and completeness of all review documentation.
• Develop materials such as forms, email correspondence, manuals, articles, lists, invoices, charts, matrices, reports, records, schedules, templates, and other documents of similar complexity.
• Organize and support team planning, arranging, and coordinating specific meetings, workshops, programs, presentations, conferences, or other group events.
• Utilize advanced computer skills for daily work; responsibilities require constant computer usage and proficiency in software programs such as Microsoft Office, all Windows software products, and web-based portals.
• Participate in portal development and enhancements, including testing and feedback to improve functionality and user experience.
• Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare & Medicaid Services, Federal Acquisition Regulation (FAR)).
• Complete other duties as assigned

Education And / Or Experience :

Core Competencies :

Attention to detail, reliability, effective communication, collaboration, accountability, time management, and problem-solving.