IDR Resolution Specialist
Location: Hybrid (must live within 60 miles of Dallas, TX)
Schedule: Full-Time
Annual Pay: $75,000
Position Summary
The IDR Resolution Specialist supports the No Surprises Act (NSA) legal workflow across Federal Independent Dispute Resolution (IDR), and post‑determination actions. This role manages high‑volume communications with certified Independent Dispute Resolution Entities (IDREs), coordinates closely with Revenue Cycle and Managed Care teams, maintains precise case records (e.g., DISP numbers, payor attribution), and drives timely, compliant execution against strict regulatory timelines.
Key Tasks & Responsibilities
- Draft, send, and track correspondence with certified IDREs; coordinate status updates and follow‑ups.
- Dispute cancellations; evaluate cancellation notices, prepare responses/appeals, and pursue reversals or re‑opening requests.
- Manage and reconcile IDR administrative and arbitration fees.
- Classify email manually; apply labels to route items to the correct case, payor, and phase.
- Initiate, reselection, and portal submissions for Federal IDR; monitor ONP/IDR timeline compliance and deadline tracking.
- Produce reporting on dispute cancellations and related operational/executive metrics; partner with leaders to define target cancellation rates.
- Prepare and send formal re‑opening requests to CMS when cancellations are issued in error; track responses and escalate as needed.
- Validate eligibility and timing and correct party/payor attribution, coordinate reselections where appropriate.
- Update case management systems.
- Review EOBs and plan information to confirm NSA applicability; document findings where carriers omit required NSA eligibility statements.
- Coordinate cross‑functionally (Legal, Revenue Cycle, Managed Care) to resolve data issues, prepare submissions, and align on dispute strategy.
Qualifications
- Prior experience in Revenue Cycle, Managed Care, and/or Legal
- 3–5+ years in legal operations, payer/provider dispute resolution, or related field
- Experience working with NSA, IDR, arbitration, or claims dispute processes (highly preferred)
- Working knowledge of the No Surprises Act, Federal IDR process, and air ambulance considerations (e.g., COP, reselection, IDRE roles)
- Proficiency with case management and collaboration tools (e.g., Appian/CRM, Outlook/Teams, SharePoint); advanced document control and email triage
- Strong legal writing and advocacy skills for formal correspondence to IDREs and CMS; ability to synthesize regulations and facts quickly
- Data fluency: ability to interpret and present insights on cancellations, win rates, timelines, dispute pathways, and payment tracking to leadership
- Knowledge of claims processing, EOB structures, payor policies, and reimbursement methodologies
- Awareness of common denial reasons, coding basics (CPT/HCPCS/ICD), and provider–payor dispute dynamics
- Must be fluent in English
Skills & Competencies
- Deadline ownership and process rigor across simultaneous disputes
- Analytical problem‑solving; meticulous record‑keeping and audit readiness
- High judgment in interpreting eligibility, timelines, and regulatory nuance
- Understanding of contracted vs. non‑contracted rates, allowed amounts, and payor negotiation practices
- Coordinating with cross‑functional teams in a regulated environment
- Experience with CMS submissions, appeals, or formal regulatory communications is a strong plus
- Experience in a position with direct responsibility for delivery of patient accounting services, healthcare billing and follow-up services
- Strong problem-solving skills, attention to detail, and ability to make timely decisions
- Experience with CMS submissions, appeals, or formal regulatory communications is a strong plus
- Education
- High School diploma or equivalent
- 2 years of post-High School education
Why Choose GMR? Global Medical Response (GMR) and its family of solutions are dedicated to delivering compassionate, quality medical care, primarily in the areas of emergency and patient relocation services. Here you’ll embark on meaningful work that will make an impact on you and the customers we serve. View the stories on how our employees provide care to the world at www.AtaMomentsNotice.com.
GMR’s Core Behaviors—keep care at the center, raise your hand, seek to understand, find a way together and be accountable—unite our teams and set us apart in emergency medical services.
EEO StatementGlobal Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability.
Check out our careers site benefits page to learn more about our benefit options.
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