Payor Dispute Coordinator

External Job Description and Responsibilities

• Prepare, initiate, and manage payment disputes through the Federal Independent Dispute Resolution (IDR) process
• Support both physician and facility-based OON claims
• Track all regulatory deadlines, including open negotiation periods, IDR filing windows, arbitrator decisions, and payment timelines
• Maintain detailed, accurate logs and documentation of dispute activity, offers, determinations, and outcomes
• Review claims to determine IDR eligibility
• Analyze payment variances using billed charges, payer reimbursement, QPA, Medicare benchmarks
• Compile, validate, and organize supporting documentation for arbitration submissions
• Ensure claim and submission accuracy to support successful arbitration outcomes and maximize provider reimbursement
• Enter and maintain accurate dispute data within internal systems, federal portals, and tracking tools
• Serve as a liaison between internal teams (billing, contracting, compliance) and external vendors (arbitration entities, consultants)
• Track, reconcile, and follow up on vendor invoices related to arbitration and dispute services
• Ensure disputes are filed in a timely, compliant, and organized manner in alignment with the No Surprises Act
• Utilize health plan provider portals and claims systems to support dispute research and follow-up
• Collaborate cross-functionally to support process improvements, audits, and special projects
• Continuously learn and apply evolving regulations related to IDR, revenue cycle workflows, and reimbursement standards

Requirements

• High school diploma or equivalent required; some college coursework preferred
• Proficiency in Microsoft Office, particularly Excel and Outlook
• Strong organizational, analytical, and problem-solving skills, including the ability to escalate issues appropriately
• Ability to work independently while collaborating effectively within a team environment
• Comfortable in a fast-paced, deadline-driven setting with frequent process changes
• Ability to handle confidential information and demonstrate HIPAA compliance
• Strong written and verbal communication skills
• Professional demeanor with a commitment to ethical and compliant business conduct
• Minimum of 1–2 years of experience (or demonstrated exposure) in one or more of the following: Healthcare revenue cycle Provider or Facility Payor disputes or arbitration support Managed care or out-of-network billing
• Healthcare revenue cycle
• Provider or Facility Payor disputes or arbitration support
• Managed care or out-of-network billing
• Direct experience with: Federal Independent Dispute Resolution (IDR) processes No Surprises Act compliance
• Federal Independent Dispute Resolution (IDR) processes
• No Surprises Act compliance
• Working knowledge of: Diagnosis-Related Group (DRG) reimbursement Medicare reimbursement structures
• Diagnosis-Related Group (DRG) reimbursement
• Medicare reimbursement structures
• Detail-oriented with strong deadline and caseload management abilities
• Analytical mindset with experience in payment comparison and variance analysis
• Clear written communication skills for arbitration narratives and supporting documentation
• Ability to manage high volumes of disputes while maintaining compliance and accuracy

Location

• Remote

Working Level