Membership Accounting Analyst, Billing
Helpware
VP of Operations, Independent Dispute Resolution
Dane Street
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- Program Leadership & Strategy:
- Lead the overall operations of Dane Street's Independent Dispute Resolution (IDR) program, ensuring compliance with federal regulations and guidelines.
- Contribute to the strategic direction of the IDR program, identifying opportunities for growth and efficiency.
- Stay informed of any changes to the IDR program and regulatory landscape, including updates from CMS, HHS, and DOJ.
- Operational Management & Workflow:
- Oversee the end-to-end workflow of IDR cases, from government portal intake to final determination.
- Optimize processes for case review, including the utilization of arbitrators and coders, to ensure timely and accurate determinations.
- Manage the integration and use of AccessDS for case tracking and management.
- Collaborate with the legal team to ensure all processes adhere to legal requirements and to address any contractual hurdles.
- Team Management & Development:
- Lead and manage a team of arbitrators, coders, and CSRs, including recruitment, training, and performance evaluation.
- Ensure arbitrators are credentialed and trained according to program requirements and internal standards.
- Oversee ongoing quality assurance for all reviews, reducing clarification needs and speeding up turnaround times.
- Financial & Administrative Oversight:
- Collaborate with the finance team to manage billing and revenue processes, focusing on upfront fees and payment collection from non-paying parties.
- Oversee the relationship with the escrow partner to ensure seamless handling of funds during the IDR process.
- Manage the budget for the IDR program, validating estimated numbers and timeframes.
- Stakeholder Communication & Relationship Management:
- Maintain effective communication with the Tri-Departments (CMS, HHS, DOJ) and other relevant entities.
- Address challenges related to incomplete information from initiating and non-initiating parties.
- Represent Dane Street in relevant industry discussions and conferences, such as NAIRO meetings.
Requirements
- Proven experience in operations leadership, preferably within healthcare, dispute resolution, or a related regulatory environment.
- Strong understanding of the Independent Dispute Resolution (IDR) process and the No Surprises Act. Prior experience preferred.
- Experience managing and optimizing complex workflows and processes.
- Demonstrated ability to lead and develop high-performing teams.
- Excellent communication, negotiation, and problem-solving skills.
- Ability to adapt to a rapidly changing regulatory environment.
