Remote Healthcare Arbitration Specialist – IDR

3 weeks ago

Manila, National Capital Region, Philippines Go Advisors LLC Full time

We are seeking a detail-oriented and highly analytical Healthcare Arbitration Specialist – IDR to manage and support the Independent Dispute Resolution process for out-of-network emergency room services in compliance with the No Surprises Act. This role involves analyzing disputed claims, preparing case submissions, and ensuring regulatory compliance, with a strong emphasis on US Emergency Room (ER) services.

The ideal candidate will have experience in healthcare revenue cycle management, medical claims negotiation or arbitration, and a solid understanding of emergency care billing practices and payer-provider dispute processes.

Key Responsibilities:
  • Review and evaluate out-of-network emergency room claims for IDR eligibility under the No Surprises Act.
  • Prepare and submit arbitration cases to certified IDR entities, including compiling supporting documentation and position statements.
  • Collaborate with legal, billing, and revenue cycle teams to ensure accurate and timely case submissions.
  • Analyze payer offers, provider charges, and benchmark rates to determine appropriate dispute positions.
  • Track the status of arbitration cases and maintain organized case documentation.
  • Communicate with payers and regulatory entities to resolve pre-arbitration negotiation efforts when applicable.
  • Interpret federal and state-level healthcare arbitration rules and ensure organizational compliance.
  • Identify trends and report on outcomes to improve negotiation strategies and reduce disputes.
  • Stay current on legislative changes affecting the IDR process and ER services reimbursement.
Qualifications:

Required:

  • Bachelor's degree in Healthcare Administration, Business, Law, or related field (or equivalent experience).
  • Minimum 3 years of experience in healthcare billing, payer relations, claims management, or legal support within a hospital, ER, or health system.
  • Working knowledge of the No Surprises Act and IDR process.
  • Experience handling emergency room billing and reimbursement processes.
  • Exceptional organizational and analytical skills.
  • Strong written and verbal communication skills.

Preferred:

  • Prior experience submitting IDR claims or supporting legal documentation for arbitration.
  • Knowledge of CPT, ICD-10, and reimbursement methodologies.
  • Familiarity with health plan networks and provider contract terms.
  • Legal or paralegal background in healthcare arbitration or medical claims a plus.
Compensation:
  • Php 55,000 to 65,000 with 13th month pay
Seniority level
  • Mid-Senior level
Employment type
  • Full-time
Job function
  • Health Care Provider
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