Position Summary:
We are seeking a highly organized and results-driven Project Manager to oversee and manage the Independent Dispute Resolution (IDR) process in accordance with federal and state regulatory requirements (e.g., the No Surprises Act). The IDR PM will coordinate cross-functional teams, manage timelines, and ensure compliance with legal standards to ensure timely and fair resolution of disputed claims between payers and providers.
Requirements
Key Responsibilities:
- Lead and manage the end-to-end IDR process, ensuring all stages are executed within regulatory timelines.
- Serve as an intermediary between operational, IT, training and finance resources
- Act as the main point of contact for internal stakeholders, external arbitrators, and regulatory bodies related to IDR cases.
- Track and report on IDR case statuses, outcomes, trends, and potential areas of risk or non-compliance.
- Ensure all documentation and decisions meet legal and audit requirements.
- Collaborate with legal, compliance, provider relations, and claims teams to gather necessary information and support dispute resolution.
- Develop and implement process improvements to optimize efficiency and accuracy of the IDR workflow.
- Stay current with evolving regulations related to the No Surprises Act, CMS IDR guidance, and applicable state laws.
- Facilitate and manage relationships with external IDR entities or arbitrators.
- Create and deliver regular reports and dashboards to leadership on IDR metrics and performance.
- Provide training and guidance to staff on IDR process and compliance.
Qualifications:
Required:
- Bachelor’s degree in business, healthcare administration, legal studies, or a related field.
- 3–5 years of project management experience, ideally in healthcare, legal, or compliance environments.
- Familiarity with the No Surprises Act and federal IDR requirements.
- Strong organizational, communication, and problem-solving skills.
- Ability to manage multiple projects and prioritize effectively under tight deadlines.
Preferred:
- Project Management Professional (PMP) certification.
- Experience in healthcare claims, provider relations, payer operations, or legal arbitration.
- Experience working with CMS or other regulatory bodies.
Skills Competencies:
- Deep understanding of dispute resolution and regulatory compliance.
- Excellent interpersonal and stakeholder management skills.
- Proficiency in project management tools (e.g., Jira, Asana, Smartsheet, Google Products).
- High attention to detail with strong analytical abilities.
- Capable of handling confidential and sensitive information with discretion.
Working Conditions:
- Hybrid or remote work may be available depending on business needs.
- May require occasional travel to attend hearings, arbitrations, or training sessions.
Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
Originally posted on Himalayas
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