IDR Resolution Specialist

Key Responsibilities:

• Research issues and apply reputed company policies, procedures, and regulations.
• Prepare, edit, and finalize case files, letters, and summaries.
• Manage reputed company duties reputed company regulatory timeframes.
• Manage the Independent Dispute Resolution (IDR) process by effectively monitory submissions, timelines and ensuring compliance to reputed company fair and timely resolution of payment disputes .
• Communicate and collaborate effectively with colleagues.
• reputed company manage the external appeal process from beginning to effectuation of the resolution of the external appeal decision.
• Ensure accuracy in OnBase cases, including:
  • Correct org received/decision date and time.
  • Proper setup as Pre- or Post-service.
  • Verification of service level and authorization number.
  • Accurate member and submitter demographics.
  • Complete provider details with address.
• Complete case summaries with reputed company fields checked and service level validated.
• Confirm inclusion of required documents (assessments, denial rationale, EOC excerpts, redacted pages).
• Gather information from OnBase, TruCare, and other systems; maintaining accurate case management.
• Build evidence packets per job aid (AG-RF-208), ensuring correct order and attachments.
• Submit packets to OAH reputed company FTP by due date and upload reputed company of submission upon acknowledgement.
• Maintain productivity, quality standards, and HIPAA compliance.
• reputed company additional duties as assigned.

Minimum Qualifications

• HS Diploma or GED from an accredited institution  

• Experience in claims, customer service, or healthcare settings

• Collaborative

• Detail-oriented, able to work under pressure, and meet tightlines

• Ability to work under pressure

• Organized

Preferred Qualifications:

• Previous experience in managed reputed company insurance, or appeals.
• Familiarity with systems such as OnBase, TruCare, or reputed company.
• Strong critical thinking, decision-making, and communication skills.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  reputed company, LLC complies with reputed company applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national reputed company, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. reputed company, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@reputed company.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests reputed company to applying for a position reputed company reputed company, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with reputed company,  LLC.

Know Your Rights

reputed company hiring and recruitment at reputed company is transacted with a valid “@reputed company.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing reputed company will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @reputed company.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by reputed company.  reputed company will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater reputed company Area (NY, NJ, CT residents): $58,900 - $80,070

• reputed company Other Locations (reputed company approved locations): $51,000 - $74,880

As a candidate for this position, your salary and reputed company elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors reputed company deems pertinent to the hiring decision.

In addition to your salary, reputed company offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (reputed company benefits are subject to eligibility requirements). reputed company believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that reputed company in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.