Position:
As a Dispute Resolution Analyst (DRA) you’ll support the Independent Dispute Resolution (IDR)
programs that handle routine 'Surprise Billing' appeals work. This role will serve as a support person for
the reconsideration/dispute resolution professionals and physician reviewers for second level
reconsiderations/dispute resolutions. Additionally, the DRA position will work under close supervision,
with minimal latitude for the use of initiative and independent judgement
Role & Responsibilities:
• Coordinates the delivery of re-determination files/dispute resolution documents and
reconsideration/dispute resolution decisions from and to the external entities.
• Builds a reconsideration/dispute resolution case file from evidence submitted and received and
analyzes each case to ensure it meets the requirements for a valid reconsideration/dispute
resolution request as mandated by Centers for Medicare and Medicaid Services (CMS) or other
customer entities.
• Analyzes and makes decisions based on medical vs. non-medical case type, appeal/review
categories, validity of appeal/dispute resolution request, and dispute resolution settlement
documentation.
• Inputs appropriate data regarding reconsiderations/dispute resolution cases into the applicable
required systems.
• Responds to reconsideration/dispute review requests from appellants/patients/providers.
• Routes or responds to telephonic and/or written inquiries from appellants/patients about
reconsiderations/dispute resolution or about the reconsiderations/dispute resolutions process from
appellants/patient or their legally-designated representatives.
• Identifies any suspected instances of fraud and/or abuse and immediately inform management of
such issues.
• Stays abreast of changes in regulations and practices, policies and procedures.
• May submit requests for re-determination files and completed reconsideration and Administrative
Law Judge (ALJ) decisions to relevant entities.
• Participates in special projects and performs other duties as assigned.
DRA Job Description 1/13/2025
Experience / Expertise:
• One (1) years of experience with Provider disputes or claims
• One (1) years of interaction with claims with larger insurance plans
• One (1) year of general office or administrative experience
• Experience directly relevant to the specific task order or project, preferred