PAYMENT DETERMINATIONS COORDINATOR - IDRE - REMOTE

MICHIGAN PEER REVIEW ORGANIZATION•Lansing, MI

8h•$60,000 - $70,000•Remote

About The Position

iMPROve Health is seeking a detail-oriented, organized, and experienced Payment Determinations Coordinator to support its Federal and State Independent Dispute Resolution Entity (IDRE) programs under the No Surprises Act (NSA). The position coordinates payment determination activities, manages dispute cases and program deadlines, maintains accurate case records, and supports compliance with Centers for Medicare & Medicaid Services (CMS) requirements and contractual obligations. The coordinator works with arbitrators, program managers, and organizational leadership to facilitate timely, accurate, and consistent case processing. The role covers dispute case coordination from intake through final resolution, case submission review, arbitrator assignments, payment determination processing, deadline monitoring, CMS portal and internal database documentation, and procedural support for arbitrators. It also supports program operations and compliance, including contract deliverables, quality reviews, risk identification, process improvement, and operational systems and workflows. The coordinator develops and maintains operational documentation and training materials, delivers onboarding and ongoing training, communicates process updates, and collaborates with internal teams and external stakeholders. The role also prepares operational reports, maintains tracking tools and dashboards, analyzes data and stakeholder feedback, and supports special projects. This is a fully remote position. Candidates must maintain reliable high-speed internet, a private and secure professional workspace, protect confidential information, work independently, meet deadlines, maintain availability during scheduled work hours, and collaborate effectively using virtual meetings and electronic systems.

Requirements

Bachelor’s degree in a healthcare-related field or equivalent relevant experience.
At least five years of project support experience in a corporate or professional environment, with demonstrated ability to meet deadlines.
Knowledge of the Federal No Surprises Act.
Strong organizational, project management, and time management skills.
Excellent written and verbal communication skills.
Strong attention to detail, reliability, accountability, and problem-solving skills.
Ability to manage multiple priorities, work independently, and meet deadlines in a fast-paced environment.
Ability to handle confidential and sensitive information appropriately.
Proficiency with Microsoft Office applications, Windows-based software, and web-based portals.
Experience developing and maintaining moderately complex spreadsheets.
Ability to navigate multiple electronic systems and cloud-based platforms while maintaining accurate records and data integrity.
Ability to collaborate effectively with internal teams and external stakeholders.
Ability to maintain reliable high-speed internet suitable for business applications and virtual communications.
Ability to maintain a private, secure, professional, and distraction-free workspace.
Ability to protect confidential information, including PHI, in accordance with HIPAA, FISMA, URAC, CMS, and organizational requirements.
Ability to maintain regular availability and communication during scheduled work hours.
Ability to collaborate through virtual meetings, approved communication tools, and electronic systems.

Nice To Haves

Master's degree in a healthcare-related or relevant field.
Familiarity with healthcare billing, reimbursement, and payer-provider processes.
Experience reviewing medical claims, remittance advice, and Explanation of Benefits (EOBs).
Understanding of quality improvement concepts.
Experience developing training materials, SOPs, and operational documentation.
Experience supporting portal development, system enhancements, or workflow improvement initiatives.
Familiarity with CMS portals, Salesforce, and other third-party platforms.

Responsibilities

Coordinate dispute cases throughout the case lifecycle, from intake through final resolution.
Review case submissions for completeness, accuracy, eligibility, and compliance with program requirements.
Coordinate case assignments to arbitrators, reviewers, and other appropriate decision-makers.
Process payment determinations following arbitrator review in accordance with established procedures and program requirements.
Monitor case status, deadlines, and outstanding activities to ensure timely resolution.
Maintain accurate case information, documentation, and communications in CMS portals and internal databases.
Respond to arbitrator inquiries and provide procedural guidance regarding case requirements and workflows.
Complete assigned contract deliverables and operational activities within established timelines.
Monitor work plans, schedules, and case-processing activities to identify potential delays, risks, or operational issues.
Ensure compliance with applicable CMS requirements, HIPAA, FISMA, URAC standards, contractual obligations, and internal policies.
Conduct quality reviews to promote accuracy, consistency, and adherence to established procedures.
Identify discrepancies, compliance concerns, and process-improvement opportunities, escalating issues as appropriate.
Assist with implementation and enhancement of operational systems, tools, and workflows.
Develop, update, and maintain SOPs, job aids, templates, FAQs, troubleshooting guides, and other operational resources.
Develop and deliver onboarding and ongoing training about IDRE workflows, CMS portal navigation, documentation standards, and communication protocols.
Collaborate with program managers and leadership to ensure training materials reflect current regulatory guidance, contractual requirements, and internal policies.
Conduct refresher training and help identify knowledge gaps and additional training needs.
Communicate process changes and updates to affected team members.
Coordinate with internal teams and external stakeholders, including arbitrators, providers, payers, legal representatives, and other dispute resolution participants.
Serve as a point of contact for procedural questions, submission requirements, and case status inquiries.
Maintain neutral, professional, and clear communication throughout the dispute resolution process.
Collaborate with operations, compliance, legal, finance, IT, and other teams to resolve issues and support program objectives.
Participate in meetings concerning operational priorities, escalations, stakeholder feedback, and policy updates.
Prepare operational reports on case volume, resolution outcomes, turnaround times, outreach activities, and performance metrics.
Maintain spreadsheets, tracking tools, and dashboards to monitor service levels, response times, case aging, and operational trends.
Analyze operational data and stakeholder feedback to identify opportunities to improve efficiency, accuracy, and service delivery.
Support special projects and other duties as assigned.