Arbitration Case Specialist - Facility IDR Claims

Job Summary The Arbitration Case Specialist – Facility IDR is a critical front-line role in our IDR engine, responsible for identifying, analyzing, and preparing high-value, facility specific, claims for federal and state arbitration under the No Surprises Act (NSA) and ERISA. You will evaluate claim eligibility, ensure compliance with regulatory portals, and drive submission accuracy to maximize provider recovery. This role demands precision, analytical rigor, and fluency in facility billing, DRG coding, and reimbursement law. Key Responsibilities Essential Job Duties • Claims Analysis & Eligibility Determination • Review 837/835 files, EOBs, and payer responses to identify NSA- and ERISA-eligible disputes. • Assess qualifying payment amount (QPA) deviations and clinical appropriateness for arbitration. • Arbitration Preparation & Submission • Compile and submit complete dispute packages via federal IDR portal and state insurance department systems. • Ensure 100% compliance with NSA timelines (e.g., 4-day batching, 30-day cooling-off). • Data Integrity & Reporting • Build and maintain Excel-based tracking with pivot tables, VLOOKUPs, and conditional logic to monitor case status, win rates, and award projections. • Deliver weekly updates to leadership on submission volume and recovery forecasts. • Cross-Functional Collaboration • Reprioritize tasks dynamically with manager/director based on client urgency and payer behavior. • Support special projects • Other Duties as Assigned Pay: $50,000.00 - $65,000.00 per year Benefits: • 401(k) • Dental insurance • Flexible schedule • Health insurance • Paid time off Experience: • Collection management: 2 years (Required) • IDR and/or out-of-network billing: 2 years (Required) • facility-based medical billing: 2 years (Required) • Facility-Based revenue cycle management: 2 years (Required) Work Location: Remote Apply tot his job Apply tot his job

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