IDR Claim Specialist

Gryphon Healthcare • Houston, TX

5d • Onsite

About The Position

IDR Claim Specialist is responsible for analyzing, organizing, and preparing documentation for eligible claims to be filed with the Texas Department of Insurance and Federal IDR in effort to promptly resolve billing disputes between out of network providers, facilities, and health plans. Arbitration: Manages disputes between out-of-network health care providers and health plans. Mediation: Manages of disputes between out-of-network facilities and health plans.

Requirements

• High School graduate or equivalent required.
• Previous experience in medical billing preferred.
• Ability to accurately interpret Eligibility of Benefits (EOB)
• Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations
• EMR, EDI and Commercial Insurance Company systems
• Ability to represent the company in a professional manner and handle patient issues with sensitivity and confidentiality.
• Detail oriented and accurate data entry skills
• Strong organizational skills and the ability to prioritize workload
• Must be able to write and speak effectively in English
• Must demonstrate interpersonal skills with all levels of the billing and management team
• Must be able to work well in a team environment
• Must have basic computer literacy that includes keyboarding skills with the ability to utilize Outlook and to navigate in a Windows environment.

Nice To Haves

• Ability to work in a fast-paced, high volume and dynamic environment.
• Requires flexible work hours in order to meet the needs of the team and company.

Responsibilities

• Work daily reports to identify claims eligible for Mediation/Arbitration by identifying insurance type, eligible dates of service and EOB check dates.
• Prepare Arbitration/Mediation documentation packets for filing with Texas Department of Insurance (TDI) and/or IDR by compiling required components, review for accuracy and recording and uploading to appropriate drive/system.
• Record and track all required case information via applicable system (i.e. Smartsheets, Excel, Word).
• Identify and communicate IDR / TDI trends with Director of Revenue Cycle Management & Legal Team.
• Participates in team meetings and provides input and feedback to support Legal Team goals, objectives, and timelines.
• Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations.
• Perform other duties and tasks assigned by Management.
• Provides support as needed to all members of the billing and auxiliary departments at Gryphon Healthcare.
• Demonstrates good customer service standards when communicating with internal and/or external customers.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED