You are self-starter and a team player. You are a skilled communicator and problem solver. You are adept at negotiating with all types of people and levels. You are exceptional at problem solving, research, and tight deadlines. You are excited to be a part of a new and growing department. You are the Independent Dispute Resolution Coordinator we have been looking for and we would like to meet you!
Who We Are
Friday Health Plans isn't your average health insurance company. We're not about unnecessary extras and confusing terminology. We cover the basic health services you'll likely use the most at a price that just might make your wallet happy. Our simple health plans and friendly service keep you covered so you're free to live every day like it's Friday.
As a Denver-based startup company, we're looking for smart, talented people like you to join us. We value collaboration, innovation, passion, and a calculated risk-taking. Now in year seven and growing rapidly, we're looking for people who lead by example, and that example is one of flexibility, reliability, and positivity. If this sounds like you, then we want you on our team.
What You'll Do
Under the general direction of the Director of IDR Department, this position has primary responsibility for monitoring & processing all open negotiation and IDR requests within the required timeframe.
Essential Duties:
- Responsible for intake, processing, coordinating requests related to open negotiations and IDR as regulated by Federal or State regulations as result of NSA
- Investigates claim information to determine appropriate allowed amount to settle IDR request
- Facilitates communication for requests to establish a mutual agreement with provider via e-mail/telephone
- Manages assigned queues and categories of IDR Department to ensure timely determinations
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Utilizes appropriate resources to gather supporting documentation:
- State or Federal Statutes
- Ensures proper documentation of all denials into software programs, to include tracking outcome for reporting to appropriate parties. Reporting bodies are:
- DOI
- CMS
- Any audits needing documentation and tracking internally
- Forms professional relationships with provider's business office or other requesting parties
- Notifies Director of high priced requests and assists with provider communication when needed
- Researches payer statutes, regulations and regional requirements to support IDR submissions
- Ensures documentation is saved in appropriate electronic locations
- Any other duties and responsibilities as assigned by Director
- Analyzing documentation and records
- Highly organized
- Ability to prioritize and make routine decisions
- Proficient in Excel
- Experience using 10-key calculator
- Willingness to work as part of a team and individual
- Ability to draft professional and effective emails
- Experience with Internet-based research
- Demonstrated experience in researching statutes and understanding regulatory documents
- Bachelor's degree in business or related field preferred, but not required
- 1-2 years' experience in health insurance, medical billing, and or claim experience
How You'll Be Valued:
- Medical, Vision, and Dental premiums covered at 100%
- Company funded health savings account (HSA)
- 401(k) and 401(k) matching
- Company paid life insurance
- Company paid short- and long-term disability insurance
- Employee assistance program
- Paid time off and 10 paid holidays
- Salary range for this position is $33,200-$37,000/ year
- A company culture that is regularly recognized as a Top Workplace by organizations such as CoBiz
- Competitive salary of $37,000-$42,000/year