IDR Resolution Specialist

About This Gig

The Appeals Review Specialist is responsible for independently managing a caseload, preparing appeal packets for external review, and ensuring timely, compliant resolutions in accordance with state and federal regulations. This role requires that appeal cases and independent review inquiries are processed, accurately, thoroughly, and within required timeframes while upholding company polices and regulatory standards. The specialist will serve as a point of contact with various regulators, entities and providers to ensure that request are handled accurately and timely while upholding company policies and regulatory standards. Key Responsibilities: Research issues and apply Healthfirst policies, procedures, and regulations. Prepare, edit, and finalize case files, letters, and summaries. Manage all duties within regulatory timeframes. Manage the Independent Dispute Resolution (IDR) process by effectively monitory submissions, timelines and ensuring compliance to achieve fair and timely re

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