IDR Program Manager at Somnia – Harrison, New York

We are hiring an IDR Program Manager to lead and own our Independent Dispute Resolution (IDR) strategy under the No Surprises Act (NSA). This is a high-impact, strategic role where you will directly influence reimbursement outcomes, payer negotiation strategy, and revenue performance across a national anesthesia organization. While a third-party vendor facilitates IDR submissions, this position provides internal ownership, oversight, and quality control for all IDR activities, ensuring claims are appropriately identified, fully supported, and managed to achieve optimal outcomes.

COMPENSATION:

• $70,000 - $80,000/year.
• Benefits: Medical, dental, vision + 401k available.
• Growth and advancement opportunities in a national organization.
• Remote work format.

I. Program Oversight & Vendor Management

• Serve as the primary internal contact for all IDR activities.
• Coordinate with external vendors to ensure accurate, timely, and high-quality filings.
• Review and approve claims for submission, ensuring completeness, accuracy, and strong supporting documentation.
• Monitor vendor performance for timeliness, quality, and compliance with regulatory requirements.

II. Strategy & Case Review

• Analyze payer reimbursement offers and develop data-driven recommended payment positions.
• Review dispute strategies and provide guidance to strengthen case outcomes.
• Collaborate with billing, clinical, and revenue cycle teams to ensure accuracy, completeness, and compliance in supporting documentation.

III. Compliance & Process Management

• Maintain audit-ready documentation for internal and external reviews.
• Ensure adherence to the No Surprises Act, state regulations, and organizational policies.
• Stay current on regulatory updates impacting IDR processes and dispute resolution strategies.

IV. Reporting & Analysis

• Track IDR volume, outcomes, success rates, and financial impact.
• Identify trends and opportunities to improve dispute outcomes and reduce dispute volume.
• Provide reporting and strategic insights to support revenue cycle, contracting, and payer strategy decisions.

REQUIRED:

• High school diploma or equivalent required; Associate’s or Bachelor’s Degree in healthcare administration, business, or a related field preferred.
• At least 5 years of proven experience in handling IDR cases required.
• Strong knowledge of the No Surprises Act (NSA) and IDR processes required.
• Demonstrated ability to analyze claims, develop strategies, and support favorable dispute outcomes required.

PREFERRED:

• Experience in anesthesia or hospital-based specialties preferred.
• Experience using electronic health record (EHR) systems and medical coding software preferred.
• Experience working with third-party IDR vendors preferred.
• Familiarity with payer reimbursement methodologies and trends preferred.

SKILLS:

• Strong analytical and problem-solving abilities.
• High attention to detail and commitment to accuracy.
• Excellent communication, collaboration, and leadership skills.
  • Ability to communicate clearly and professionally with insurance companies, patients, and providers.
• Ability to manage multiple priorities in a fast-paced, results-oriented environment.
• Strategic thinker with the ability to influence internal teams and leadership.