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Independent Dispute Resolution (IDR) Claims / OON Specialist

Independent Dispute Resolution (IDR) Claims / OON Specialist

Exceptional Healthcare Inc.Dallas, TX, US
30+ days ago
Job type
  • Full-time
  • Quick Apply
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 :

  • Experience with State or Federal Independent Dispute Resolution processes (e.g., TDI, NSA).
  • Familiarity with industry regulations and dispute resolution protocols.
  • Proficiency with medical coding, billing systems, and healthcare software.
  • EDUCATION / EXPERIENCE
  • High School Diploma or equivalent required.
  • Associate’s or Bachelor’s degree in healthcare administration, business, or related field is preferred.
  • Minimum of 3 years of experience in medical billing, collections, and appeals.
  • Demonstrated experience in dispute resolution, preferably in a healthcare setting.
  • PHYSICAL DEMANDS
  • Requires visual acuity to inspect and analyze work close to the eyes and ability to hear sound with or without correction; Ability to climb, stoop, kneel, reach, stand, walk pull, push lift, and able to exert up to 40 pounds of force occasionally and / or up to 10 pounds of force constantly to move objects.
  • Moderate physical activity, performing somewhat strenuous daily activities of a primarily administrative nature.
  • The physical demands for this position include adequate vision, hearing, and repetitive motion.
  • Ascending or descending stairs, ramps, and the like, using feet and legs and / or hands and arms.
  • Substantial movements (motion) of the wrist, hands, and / or fingers in a repetitive manner - Bending legs downward and forward by bending leg and spine - Standing, particularly for sustained periods of time.

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

  • Raising objects from a lower to a higher position or moving object horizontally from position to position WORK CONDITIONS
  • While performing the duties of this job, the employee is frequently required to stand, walk, sit, reach with hands and arms, and talk or hear.
  • The employee is occasionally required to stoop, kneel, crouch, or crawl and taste or smell.
  • The employee is required to have close visual acuity to perform an activity such as :
  • preparing and analyzing data and figures, transcribing, and viewing a computer terminal.
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