We are seeking an experienced IDR Specialist to manage the Independent Dispute Resolution (IDR) process for U.S. healthcare providers.

Under the No Surprises Act (NSA), IDR is a federal binding arbitration process used to resolve payment disputes between healthcare providers and insurance companies when an agreement cannot be reached through negotiation. The IDR Specialist will be responsible for managing disputes from initial review through submission, tracking, and resolution.

The ideal candidate has robust knowledge of U.S. medical billing, insurance reimbursement, claims, denials, and the No Surprises Act, along with excellent attention to detail and documentation skills.

Role & responsibilities

Manage the complete IDR process for eligible out-of-network claims under the No Surprises Act.

Review claims, EOBs/ERAs, payer correspondence, patient information, and supporting documentation.

Determine whether claims meet IDR eligibility requirements.

Review payer reimbursement, contracted rates, and applicable payment methodologies.





Prepare and submit IDR disputes through the appropriate federal or state IDR process.

Develop and organize supporting documentation and payment justification.

Research and analyze reimbursement rates, including applicable Qualifying Payment Amount (QPA) information.

Communicate with payers and providers regarding disputed claims and payment offers.

Monitor submission deadlines, response periods, and arbitration timelines.

Track cases from initiation through final determination and payment.

Maintain accurate records of all IDR cases, documentation, communications, and outcomes.

Review IDR determinations and follow up on payments or discrepancies.

Identify trends in payer underpayments and recurring reimbursement issues.

Maintain compliance with applicable federal and state requirements.

Work closely with billing, AR, denial, and management teams to identify claims appropriate for IDR.

Preferred candidate profile

Experien

📌 Experienced IDR Specialist For U.S. Healthcare Providers (Sahibzada Ajit Singh Nagar)
🏢 Wenour Enterprises
📍 Sahibzada Ajit Singh Nagar