Independent Dispute Resolution (IDR) Claims / OON Specialist

Job Description

Job Description

Job Summary : We are seeking an experienced and highly motivated Independent Dispute Resolution (IDR) Claims / OON Specialist to join our team. This role requires expertise in medical billing, collection, and appeals and a strong understanding of dispute resolution processes. The ideal candidate will be responsible for managing and resolving medical billing disputes efficiently and in compliance with regulatory requirements.

The Independent Dispute Resolution (IDR) Claims / OON Representative needs to assist in managing claims disputes under the No Surprises Act. This position requires an in-depth understanding of healthcare billing, regulations, and dispute resolution processes, ensuring compliance with the No Surprises Act and protecting patients from surprise medical bills.

As an IDR Representative, you will be responsible for managing disputes between healthcare providers and insurers, determining the appropriate payment amounts for out-of-network services, and working to resolve disputes efficiently and effectively. This is a key role in helping ensure fair and transparent billing practices by federal regulations.

Job Responsibilities / Duties :

• Review and resolve medical billing, collection, and appeals disputes.
• Work with insurance companies, medical providers, and other stakeholders to resolve claims.
• Ensure compliance with all federal and state regulations in dispute resolution.
• Communicate effectively with all parties to facilitate the resolution of claims.
• Maintain accurate documentation of dispute resolution processes and outcomes.
• Prepare and submit required reports and documentation promptly.
• Proven experience with medical billing, collections, and appeals processes.
• Strong understanding of medical billing codes and regulations.
• Excellent communication and negotiation skills.
• Strong attention to detail and organizational abilities.
• Ability to work independently and as part of a team.
• Ability to handle complex and sensitive information with confidentiality and professionalism.

Qualifications & Experience :

EDUCATION / EXPERIENCE

PHYSICAL DEMANDS

Using upper extremities to exert force to draw, drag, haul or tug objects in a sustained motion.

WORK CONDITIONS

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