SUMMARY OF POSITION
The Pre-Independent Dispute Resolution (IDR) Open Negotiations Specialist is responsible for managing the open negotiation phase required under the No Surprises Act prior to initiating the federal Independent Dispute Resolution (IDR) process. This role facilitates timely and compliant negotiations with payers, prepares and submits open negotiation notices, tracks statutory deadlines, and works to resolve payment disputes prior to arbitration. The Specialist plays a critical role in maximizing reimbursement while ensuring full compliance with federal regulations.
ESSENTIAL JOB DUTIES
Initiate and manage the open negotiation process in accordance with No Surprises Act requirements.
Prepare and submit open negotiation notices to payers within required timeframes.
Communicate professionally with payer representatives regarding disputed claims and payment offers.
Analyze payer responses and counter offers during the open negotiation period.
Work collaboratively with internal teams to evaluate settlement opportunities and negotiation strategies.
Document all negotiation activity and outcomes in accordance with compliance standards.
MARGINAL/NONESSENTIAL JOB DUTIES/OTHER FUNCTIONS
Demonstrated ability to efficiently use a computer and keyboard for sustained data entry, written communications, and portal-based work.
Strong attention to accuracy and detail.
Must be able to lift 10 pounds at a time.
Must be able to access and navigate each department at the organization’s facilities.
Frequent engagement in verbal and written communication with employee management and external parties. Clear communication skills are essential.
MINIMUM REQUIRED QUALIFICATIONS
Experience in healthcare revenue cycle, medical billing, or payer relations.
Strong written and verbal communication skills.
Excellent organizational skills and attention to detail.
Ability to manage multiple negotiations and deadlines simultaneously.
Regular and reliable attendance
PREFERRED QUALIFICATIONS
Experience directly managing open negotiations under the No Surprises Act.
Familiarity with CMS guidance, payer contracting, and reimbursement methodologies.
Working knowledge of the No Surprises Act and pre-IDR open negotiation requirements.
Proficiency with payer portals and tracking tools. (e.g., Excel, revenue cycle software).
WORKING CONDITIONS/ENVIRONMENT
Inside, office environment.
The majority of the workday is spent sitting at a desk or workstation while performing tasks on a computer, such as data entry, email communication, and documentation. Should be comfortable with prolonged periods of sitting.
The ability to type and use a keyboard extensively. Proficiency in typing and computer skills are essential for this role.
Frequently engage in verbal and written communication with employee management and external parties. Clear and effective communication skills are essential.
Must be able to lift 10 pounds at times. Occasionally need to handle files, paperwork, or office supplies, which could involve lifting light objects.
Must be able to read documents, computer screens, and other materials.
Must be able to access and navigate each department at the organization’s facilities.
