Independent Dispute Resolution Analyst

Successful applicants for this position must be fully vaccinated against COVID-19 as a condition of employment. Vaccine verification will be required.

POSITION SUMMARY

The Independent Dispute Resolution (IDR) Analyst is responsible for researching state and payor IDR protocols and analyzing eligible claims that receive under payment or non-payment.  This position oversees the billing vendor and process of dispute resolution claim submission and payment requests with payors and third-party dispute resolution entities. 

 

PRIMARY RESPONSIBILITIES

• Develop, train, and deploy a process to submit and monitor independent dispute resolution requests for assigned payors and states.
• Submits test cases to ensure eligibility to dispute resolution entities.
•  Monitors claims, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for assigned payors and states.
•  Conducts monthly audits on third-party vendors to ensure process and workflows are being adhered to and compliant.
•  Establishes an ongoing working relationship with other departments impacting dispute and appeal resolution.
• Works closely with the vendor operations teams to oversee operations activity that directly impact assigned payors dispute and appeal process.
• Tracks outcomes of payment resolution and negotiated claims to ensure goals are met.
• Participates in weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.
• Continually reviews and monitors payor and state dispute regulatory changes, research, evaluates, and interprets guidance from a variety of sources to determine departmental actions.
• Coordinates with Management to ensure thorough understanding of trends/issues affecting dispute performance.

 

QUALIFICATIONS:

•  Bachelor's Degree healthcare related field of study or equivalent experience.
• Minimum of 5 years of experience in medical billing and Insurance collections, dispute resolution or appeals experience preferred.
• Minimum of 3 years of experience in revenue cycle or claim analysis.
• Project management experience preferred.
• Knowledge of CPT/HCPCS. ICD-10, modifier selection, and UB revenue codes.

 

KNOWLEDGE, SKILLS AND ABILITIES

• Proficiency with medical or claim billing systems, Microsoft Excel, reporting software and basic procedure coding knowledge.
• Knowledge of medical terminology and abbreviations, and health care nomenclature and systems.
• Strong communication (verbal and written), organizational, problem solving and team player skills.
• Knowledge of appeal and independent dispute resolution regulations.
• Ability to navigate across multiple customer demands and balance competing priorities successfully.
• Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner.
•  Ability to independently solve complex problems using critical thinking skills.
• Maintains confidentiality of sensitive information.
• Analytical skills required.
• Ability to think critically and identify the global impact across the revenue cycle with a solution-oriented approach.
• Ability to develop, implement and produce complex analysis and reports.

 

The pay range for this role is $67,400 - $101,200. Actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.  

 

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#REMOTE

 

The pay range is listed and actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.Colorado $67,400—$101,200 USD

OUR OPPORTUNITY

Natera™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. Our aim is to make personalized genetic testing and diagnostics part of the standard of care to protect health and enable earlier and more targeted interventions that lead to longer, healthier lives.

The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other. When you join Natera, you’ll work hard and g