Payer Dispute Analyst (58071) at ApolloMD in ATLANTA, GA 30328

Job description

• Position Type
• Full Time
• The Payer Dispute Analyst supports the organization's efforts to resolve disputes with payers. This role focuses heavily on the Independent Dispute Resolution (IDR) process under the No Surprises Act and state dispute resolution processes, while maintaining flexibility to handle additional payer dispute matters and processes as needed. The Analyst will review and analyze claims for reimbursement and work collaboratively with internal teams and external entities to secure appropriate reimbursement.

Responsibilities

• Review, analyze, and interpret claims data to ensure accurate payment in alignment with applicable policies and regulatory requirements.
• Research and prepare reports identifying trends, recurring issues, and high-level reimbursement concerns.
• Manage designated aspects of the No Surprises Act IDR and state dispute resolution processes, from case initiation through final payer determination.
• Prepare and submit Final Offers through the CMS portal, ensuring accuracy and strict adherence to regulatory deadlines.
• Oversee the resolution process for claims in dispute, including documentation, submission, and follow-up to ensure proper reimbursement.
• Compile and organize supporting materials including Position Statements (Briefs), Good Faith Negotiation documents, and relevant clinical documentation.
• Track submission timelines and proactively manage deadlines to ensure timely case processing.
• Maintain comprehensive, audit-ready records of all dispute submissions and outcomes.
• Collaborate with legal, revenue cycle, and clinical teams to support dispute strategies and documentation needs.
• Maintain up-to-date knowledge of payer policies, state/federal regulations, and industry best practices related to dispute resolution.
• Assist in developing process improvements to enhance efficiency, accuracy, and compliance.
• Support special projects and other duties as assigned to meet departmental and organizational objectives.

Requirements

• Qualifications
• Qualifications
• 2+ years of experience in healthcare claims, payer disputes, or revenue cycle.
• Strong organizational skills with the ability to manage multiple priorities in a high-volume, fast-paced environment.
• Excellent verbal and written communication skills.
• Proactive, team-oriented mindset with a high degree of professionalism.
• Strong problem-solving and analytical abilities.
• Proficiency in Microsoft Excel and other Microsoft Office applications.
• High School Diploma or equivalent required; Bachelor's degree preferred.
• Working knowledge of the No Surprises Act and federal IDR processes.
• Experience with accounts receivable, payer disputes, or legal disputes.
• Familiarity with the Athena billing system.
• Experience with state dispute resolution processes or similar payer dispute workflows.
• Background in medical billing, claims processing, or payer-provider dispute resolution.

Skills

Required

• Strong organizational skills
• Proactive, team-oriented mindset
• High degree of professionalism