IDR Business Analyst
DOMA Technologies, Virginia Beach, VA, United States
Description
The Business Analyst will support the Financial Manager in executing the Federal Independent Dispute Resolution Entity (IDRE) review process. This position assists with tracking and reconciling case reviews, ensures accurate, compliant, and timely processing of case reviews, and assists in implementing operational improvements within the IDRE program.
Primary Duties
Supports tracking and reconciliation of case reviews/disputes, ensuring timely and accurate processing and monitoring of the work queues and correspondence.
Assists in developing and refining workflows, templates, and documentation tools that support the review process and reporting functions.
Conducts research to ensure practices are compliant with the Federal IDR process.
Performs research and analysis for any disputes or discrepancies with parties regarding disputes.
Audits and reviews the IDR process to ensure data accuracy.
Uses critical thinking to define problems, identify root causes, and recommend solutions.
Reconciles and updates portals to ensure accurate entry of dispute information.
Stays up-to-date on CMS NSA Guidelines and adapts to changes in the No Surprise Act.
Adheres to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare & Medicaid Services, Federal Acquisition Regulation (FAR)).
Completes other duties as assigned.
Qualifications Essential Education
High School Diploma or GED and 1 to 3 years of related experience and/or training; or equivalent combination of education and experience.
Associate’s degree in healthcare or business preferred.
1-3 years of experience working with medical billing, claims, appeals, coding, customer service, insurance verification, and medical records; financial and revenue cycle analysis preferred.
Essential Skills
Strong analytical and organizational abilities; skilled at managing multiple tasks while maintaining accuracy.
Effective written and verbal communication; able to convey information clearly and professionally.
Demonstrated ability to track, analyze, and interpret data.
Ability to work independently with minimal direction.
Proficiency in Microsoft Office Suite, especially Excel (pivot tables, formulas, data analysis), Word, and PowerPoint.
Essential Knowledge
Computer usage is constant and requires knowledge and experience in the application and operation of software programs such as Microsoft Office, all Windows software products, and web-based portals. Work may involve development of moderately complex spreadsheets, multitasking group projects, and assistance with portal development and enhancements. Core competencies include attention to detail, reliability, effective communication, collaboration, accountability, time management, and problem‑solving skills.
Work Environment and Physical Demands This is an office position. The employee will regularly work in a climate‑controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.
EEO Statement Commence is an equal employment opportunity employer. All personnel processes are merit‑based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.
If you need assistance or an accommodation due to a disability, you may contact us at 757-306-4920 or hr@commence.ai.
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Primary Duties
Supports tracking and reconciliation of case reviews/disputes, ensuring timely and accurate processing and monitoring of the work queues and correspondence.
Assists in developing and refining workflows, templates, and documentation tools that support the review process and reporting functions.
Conducts research to ensure practices are compliant with the Federal IDR process.
Performs research and analysis for any disputes or discrepancies with parties regarding disputes.
Audits and reviews the IDR process to ensure data accuracy.
Uses critical thinking to define problems, identify root causes, and recommend solutions.
Reconciles and updates portals to ensure accurate entry of dispute information.
Stays up-to-date on CMS NSA Guidelines and adapts to changes in the No Surprise Act.
Adheres to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare & Medicaid Services, Federal Acquisition Regulation (FAR)).
Completes other duties as assigned.
Qualifications Essential Education
High School Diploma or GED and 1 to 3 years of related experience and/or training; or equivalent combination of education and experience.
Associate’s degree in healthcare or business preferred.
1-3 years of experience working with medical billing, claims, appeals, coding, customer service, insurance verification, and medical records; financial and revenue cycle analysis preferred.
Essential Skills
Strong analytical and organizational abilities; skilled at managing multiple tasks while maintaining accuracy.
Effective written and verbal communication; able to convey information clearly and professionally.
Demonstrated ability to track, analyze, and interpret data.
Ability to work independently with minimal direction.
Proficiency in Microsoft Office Suite, especially Excel (pivot tables, formulas, data analysis), Word, and PowerPoint.
Essential Knowledge
Computer usage is constant and requires knowledge and experience in the application and operation of software programs such as Microsoft Office, all Windows software products, and web-based portals. Work may involve development of moderately complex spreadsheets, multitasking group projects, and assistance with portal development and enhancements. Core competencies include attention to detail, reliability, effective communication, collaboration, accountability, time management, and problem‑solving skills.
Work Environment and Physical Demands This is an office position. The employee will regularly work in a climate‑controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.
EEO Statement Commence is an equal employment opportunity employer. All personnel processes are merit‑based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.
If you need assistance or an accommodation due to a disability, you may contact us at 757-306-4920 or hr@commence.ai.
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