No Surprises Act IDRE Billing & Coding Specialist

Employment Type: Full-time Location Type: Remote

Position Overview

Dane Street is seeking a No Surprises Act IDRE Billing & Coding Specialist with exclusive experience in Independent Dispute Resolution (IDRE) cases under the No Surprises Act. This role requires a deep understanding of IDRE processes and compliance requirements. Join our exciting work environment with competitive compensation and strong growth potential.

Job Summary

This new program on the group health side of our business allows you to leverage your clinical knowledge to review reports accompanying medical records. Your primary responsibility will be to ensure the accuracy of medical billing information and coding. You will collaborate with other reviewers and their office teams to ensure clarity of information, address all questions posed, and ensure reports are returned within client deadlines.

Core Duties & Responsibilities

• Evaluates the appropriateness of codes and determines if they meet all established program standards.
• Ensures medical records are appropriately matched to codes; obtains missing records if necessary.
• Reads and applies policy guidelines and healthcare terminology to delineate when criteria are met or not met.
• Evaluates claims for conflict of interest and criteria appropriateness.
• Works within established timeframes set by program parameters.
• Provides strong customer service skills and works closely with clients on a case-by-case basis to ensure complete, timely, and error-free quality assurance of cases.
• Provides clinical oversight for complex cases requiring additional review before client return.
• Serves as an additional level of QA and clinical knowledge/review for cases with quality issues.

Requirements

Required Education & Experience:

• Must possess a CPC, APCC, or DRG coder certification.
• Payment integrity or professional bill review experience is strongly preferred.
• Out-of-network bill review experience is a plus.
• Experience working in a remote environment is preferred.
• Experience in a medical office or healthcare background is required.

Required Skills:

• Must work with a sense of urgency and meet deadlines.
• Must be self-motivated with a strong drive for performance excellence.
• Excellent written and verbal communication skills are required.
• Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc., is a plus).
• Attention to detail is REQUIRED.

PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Benefits

We offer generous Paid Time Off, an excellent benefits package, and a competitive salary. If you are an outstanding candidate, thrive in a fast-paced environment, and are interested in doing meaningful work that impacts others' lives, we encourage you to apply!

About Dane Street

Dane Street is a fast-paced, Inc. 500 Company with a high-performance culture, seeking insightful, astute, and forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Additional Details

• Published: 2025-04-15
• Department: (Not specified)
• Language: en