IDR Business Analyst

Commence•Virginia Beach, VA

31d

About The Position

The Business Analyst will support the Financial Manager in executing the Federal Independent Dispute Resolution Entity (IDRE) review process. This position assists with tracking and reconciling case reviews, ensures accurate, compliant, and timely processing of case reviews and assists in implementing operational improvements within the IDRE program. At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

Requirements

High School Diploma or general education degree (GED) and 1 to 3 years’ related experience and/or training; or equivalent combination of education and experience
Computer usage is constant and requires knowledge and experience in the application and operation of software programs such as Microsoft Office, all Windows software products, and web-based portals. Work may involve the development of moderately complex spreadsheets, multi-tasking group projects, and assistance with portal development and enhancements. Core competencies include attention to detail, reliability, effective communication, collaboration, accountability, time management, and problem-solving skills.
Strong analytical and organizational abilities; skilled at managing multiple tasks while maintaining accuracy
Effective written and verbal communication; able to convey information clearly and professionally.
Demonstrated ability to track, analyze, and interpret data.
Ability to work independently with minimal direction
Proficient in Microsoft Office Suite, especially Excel (pivot tables, formulas, data analysis), Word, and PowerPoint.

Nice To Haves

Associate’s degree in healthcare or business preferred.
1-3 years’ experience working with medical billing, claims, appeals, coding, customer service, insurance verification, and medical records, with financial and revenue cycle analysis preferred.

Responsibilities

Supports tracking and reconciliation of case reviews/disputes, ensuring timely and accurate processing and monitoring of the work queues and correspondence.
Assists in developing and refining workflows, templates, and documentation tools that support the review process and reporting functions.
Conducts research to ensure practices are compliant with the Federal IDR process.
Perform research and analysis for any disputes or discrepancies with parties regarding disputes.
Audit and review the IDR process to ensure data accuracy.
Use critical thinking to define problems, identify root causes, and recommend solutions.
Reconciles and updates portals to ensure accurate entry of dispute information.
Stay up-to-date on CMS NSA Guidelines and adapt to changes in the No Surprise Act.
Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare & Medicaid Services, Federal Acquisition Regulation (FAR)).
Complete other duties as assigned.