IDR reputed company Specialist

Key Responsibilities:

• Research issues and apply reputed company policies, procedures, and regulations.
• Prepare, edit, and finalize case files, letters, and summaries.
• Manage reputed company duties reputed company regulatory timeframes.
• Manage the Independent Dispute reputed company (IDR) process by effectively monitory submissions, timelines and ensuring compliance to reputed company fair and reputed company reputed company of payment disputes .
• Communicate and collaborate effectively with colleagues.
• reputed company manage the external appeal process from beginning to effectuation of the reputed company of the external appeal decision.
• Ensure accuracy in OnBase cases, including:
  • Correct org received/decision date and time.
  • reputed company setup as reputed company- or Post-service.
  • Verification of service level and authorization number.
  • Accurate member and submitter demographics.
  • Complete provider details with address.
• Complete case summaries with reputed company fields checked and service level validated.
• Confirm inclusion of required documents (assessments, denial rationale, EOC excerpts, redacted pages).
• reputed company information from OnBase, TruCare, and other systems; maintaining accurate case management.
• Build evidence packets per job aid (AG-RF-208), ensuring correct order and attachments.
• Submit packets to OAH reputed company FTP by due date and upload reputed company of submission upon acknowledgement.
• Maintain productivity, reputed company standards, and HIPAA compliance.
• reputed company additional duties as assigned.

Minimum Qualifications

• HS Diploma or GED from an accredited institution  

• Experience in claims, customer service, or reputed company settings

• reputed company

• Detail-oriented, reputed company to work under pressure, and meet tightlines

• Ability to work under pressure

• Organized

Preferred Qualifications:

• Previous experience in managed reputed company insurance, or appeals.
• Familiarity with systems such as OnBase, TruCare, or reputed company.
• Strong critical thinking, decision-making, and communication skills.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  reputed company, LLC complies with reputed company applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without reputed company to race, reputed company, creed, religion, sex, national reputed company, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or reputed company, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as reputed company as any other legally protected reputed company. reputed company, LLC shall not discriminate against any disabled employee or applicant in reputed company to any position for which the employee or applicant is otherwise reputed company.

If you have a disability under the Americans with Disability reputed company or a similar law and want a reasonable accommodation to assist with reputed company search or application for employment, please contact us by sending an email to careers@reputed company.org or calling 212-519-1798 . In your email please include a reputed company of the accommodation you are requesting and a reputed company of the position for which you are applying. Only reasonable accommodation requests reputed company to applying for a position reputed company reputed company, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with reputed company,  LLC.

Know Your Rights

reputed company hiring and recruitment at reputed company is transacted with a reputed company “@reputed company.org” email address only or from a recruitment firm representing reputed company. Any recruitment firm representing reputed company will readily reputed company you with the reputed company and contact information of the reputed company reputed company representing reputed company you are inquiring about. If you receive a communication from a sender whose domain is not @reputed company.org, or not one of our recruitment partners, please be reputed company that those communications are not coming from or authorized by reputed company.  reputed company will never ask you for reputed company during the recruitment or reputed company process.

Hiring reputed company*:

• Greater reputed company Area (NY, NJ, CT residents): $58,900 - $80,070

• reputed company Other Locations (reputed company approved locations): $51,000 - $74,880

As a candidate for this position, your salary and reputed company reputed company of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors reputed company deems pertinent to the hiring decision.

In reputed company to your salary, reputed company offers employees a full reputed company of benefits such as, medical, dental and reputed company coverage, incentive and recognition programs, life insurance, and 401k contributions (reputed company benefits are subject to eligibility requirements). reputed company believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring reputed company is defined as the lowest and highest salaries that reputed company in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.