IDR Program Manager

Somnia, Inc.

12h

About The Position

The IDR Program Manager will oversee the Independent Dispute Resolution (IDR) process under the No Surprises Billing Act (NSA) on behalf of the organization, with a specific focus on anesthesia-related claims. While a third-party vendor is responsible for filing IDR disputes, the Program Manager will serve as the internal owner of the process—ensuring appropriate claims are identified, properly supported, and strategically managed to drive favorable outcomes. This role requires a strong understanding of the NSA, payer reimbursement trends, and the unique billing dynamics of anesthesia services.

Requirements

Excellent communication and customer service skills, with the ability to communicate clearly and professionally with insurance companies, patients, and providers.
Attention to detail and ability to maintain a high level of accuracy.
Exceptional leadership skills.
Proficiency in using electronic health record (EHR) systems and coding software.
Ability to work independently and manage multiple tasks effectively.
High school diploma or equivalent required; Associate’s or Bachelor’s Degree in healthcare administration, business, or a related field is preferred.
At least 5 years of experience in handling IDR cases required.
Proven experience in an IDR Specialist or similar Medical Billing role required.

Nice To Haves

Experience in the Anesthesia space not required, but preferred.

Responsibilities

Serve as the internal point of contact for all IDR-related activities and coordinate closely with the third-party vendor responsible for IDR filings.
Ensure that all eligible anesthesia claims are accurately flagged and prioritized for IDR consideration.
Review and approve claims referred to the vendor, ensuring supporting documentation and rationale are complete and compelling.
Monitor vendor performance and adherence to timelines, quality standards, and compliance requirements.
Analyze payer payment offers and develop data-backed recommendations for the company’s proposed payment amounts.
Review case strategies proposed by the vendor and provide feedback or supplemental evidence to strengthen the organization’s position.
Collaborate with clinical and billing teams to ensure data consistency and transparency in claim support documentation.
Maintain thorough documentation of IDR case activity, outcomes, and justification for internal auditing and regulatory compliance.
Stay current on changes in the No Surprises Billing Act, IDR guidelines, and state-level surprise billing laws affecting anesthesia services.
Support internal audits and compliance reviews related to IDR activity and reporting.
Develop and maintain dashboards and reports tracking IDR volumes, success rates, financial impact, and payer trends.
Identify opportunities to reduce disputes, improve negotiation leverage, or refine claim documentation based on case learnings.
Present strategic insights and trends to leadership to support broader revenue cycle and contract negotiation efforts.