NSA & IDR Reimbursement Specialist - Digitech - Remote

Sarnova

8d•Remote

About The Position

The NSA & IDR Reimbursement Specialist is responsible for managing the No Surprises Act (NSA) reimbursement process for out-of-network air ambulance claims. This position reviews payer reimbursement determinations, identifies claims eligible for Open Negotiation and Independent Dispute Resolution (IDR), and manages cases through final resolution to maximize reimbursement and ensure regulatory compliance. The ideal candidate possesses strong analytical skills, knowledge of healthcare reimbursement processes, and the ability to manage multiple deadlines in a fast-paced environment.

Requirements

High School Diploma or equivalent required
Minimum of 2 years of experience in healthcare claims processing, billing, accounts receivable, appeals, payer relations, or reimbursement recovery.
Hands-on experience preparing and submitting insurance appeals, including understanding payer denial codes and timely filing limits.
Experience working with commercial insurance payers.
Familiarity with ICD-10, HCPCS, and general medical terminology.
Proficiency with various web platforms including billing software and payer portals.
Excellent computer skills including Microsoft Word, Excel, and Outlook.
Strong verbal and written communication skills.
Strong interpersonal, organizational, and time management skills.
Strong problem-solving, investigative, critical thinking, and analytical skills.
Ability to manage multiple priorities, meet strict deadlines, and work in a fast-paced environment with minimal supervision.
Prior customer service experience with the ability to collaborate across departments and teams.
Ability to independently manage all aspects of the role, including productivity goals and business practices in a remote environment.

Nice To Haves

Associate degree preferred.
EMS, air ambulance, healthcare transportation, or medical billing experience.
Knowledge of the No Surprises Act (NSA) and Federal Independent Dispute Resolution (IDR) process.
Experience with payer appeals, arbitration, negotiations, reimbursement recovery, or dispute resolution.
Knowledge of healthcare reimbursement methodologies and payer contracting concepts.
Experience working with federal or state healthcare regulations.
Collections experience.

Responsibilities

Review out-of-network air ambulance claims to determine eligibility under the No Surprises Act.
Analyze payer reimbursement determinations and identify underpayment opportunities.
Initiate and manage Open Negotiation requests within federal regulatory timelines.
Prepare, submit, and track Independent Dispute Resolution (IDR) cases through the federal IDR portal.
Gather and organize supporting documentation, reimbursement data, and case narratives for dispute submissions.
Communicate directly with insurance carriers, third-party administrators, and other stakeholders regarding payment disputes and reimbursement negotiations.
Monitor all NSA and IDR deadlines to ensure timely filings and compliance.
Coordinate administrative and arbitrator fee payments associated with IDR cases.
Track IDR determinations and ensure payers comply with awarded reimbursement amounts.
Escalate unresolved payment issues and payer non-compliance when appropriate.
Maintain accurate records of negotiations, submissions, determinations, and collections.
Prepare reports related to NSA activity, reimbursement recoveries, payer trends, and dispute outcomes.
Monitor regulatory updates and payer policy changes affecting air ambulance reimbursement.
Collaborate with billing, accounts receivable, compliance, legal, and operational teams to resolve claim issues and improve reimbursement outcomes.