Clearesthealth Com
Dispute Specialist / Senior Dispute Specialist
New York, USA · Senior
Sponsorship not specifiedDetected 64 days ago
Product ManagementNegotiationRadiologyCommunication
About the role
- This role is for someone who is already familiar with the federal IDR portal and ready to operate at scale.
Responsibilities
- Manage a portfolio of federal NSA IDR disputes from eligibility review through IDRE determination, owning every step: open negotiation outreach, IDR initiation, batching decisions, written submissions, offer selection, and post-determination reconciliation.
- Build the strongest possible case for each dispute by analyzing the QPA, gathering supplemental information (provider training, complexity, market data, acuity, prior contracted rates, comparable case data), and crafting clear, well-cited written narratives that IDREs find persuasive.
- Track outcomes, root-cause losses, and feed learnings back into our playbooks, templates, and product roadmap. (Senior level) Serve as a technical reviewer on complex or high-dollar disputes, mentor newer specialists, and partner with engineering and operations to improve our internal tooling.
- We're hiring Dispute Specialists at both the Specialist and Senior Specialist levels to own end-to-end Independent Dispute Resolution (IDR) cases.
- The Role We're hiring Dispute Specialists at both the Specialist and Senior Specialist levels to own end-to-end Independent Dispute Resolution (IDR) cases.
- Manage a portfolio of federal NSA IDR disputes from eligibility review through
Requirements
- Required 3+ years (Specialist) or 5+ years (Senior) of hands-on IDR experience filing federal NSA disputes through the CMS Federal IDR portal - not adjacent revenue cycle work, actual IDR case ownership.
- Strong working knowledge of the No Surprises Act, QPA methodology, and the additional information factors IDREs weigh under 45 CFR § 149.510.
- Proven track record negotiating with commercial payers (UnitedHealthcare, Anthem/Elevance, Aetna, Cigna, BCBS plans) during open negotiation, with examples of disputes you've closed pre-IDR.
- Experience with batching strategy and the procedural rules around batched and bundled disputes.
- Familiarity with at least one state IDR program (Texas SB 1264, New York's IDR process, Georgia, New Jersey, or similar) and an appetite to learn the others.
- Comfort working in spreadsheets and dispute-management tooling
- you can pull a pivot, spot an outlier in a batch, and explain a number to a non-finance audience.
Nice to have
- Experience in a specific specialty where IDR volume is heavy (emergency medicine, anesthesiology, radiology, pathology, air ambulance).
- Familiarity with the CMS public IDR data and how to use prior determinations as supporting evidence.
- The impact is direct and measurable.
- You'll be supported by a tech stack that automates the parts of IDR that should be automated - so your time goes to the judgment calls that actually move outcomes, not to portal data entry.
- A small, senior team where your wins are visible and your playbook ideas ship.
Benefits
- About Clearest Health Clearest Health helps providers get paid fairly for out-of-network care.
Apply directly at Clearesthealth Com →Create a free account for alerts like thisView Clearesthealth Com immigration profile
This listing is sourced directly from Clearesthealth Com's careers page and normalized into a canonical job model.