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Role Description

The Project Specialist assists with the daily workflow administrative responsibilities that support the Federal Independent Dispute Resolution Entity (IDRE) review process. The Project Specialist aids in facilitating the processing of IDR reviews and completes other duties as assigned under the direction of the IDR/IIDR Director and Program Manager. The specialist will work closely with the IDRE team and all reviewers to ensure case timeliness.

Responsibilities also include working with external customers to ensure receipt of all necessary review documentation.

Duties and Responsibilities:

• Assist the team with facilitating review requests in a timely and efficient manner, including implementing processes to track and monitor individual case progress and timeliness.
• Collaborate with IDRE team members to achieve department goals, including prescreening IDR (Independent Dispute Resolution) cases for eligibility using defined criteria.
• Apply knowledge and experience in claims, appeals, and denials to support review and resolution processes, ensuring accuracy, compliance, and timeliness.
• Coordinate, document, and track pertinent data to meet team informational and reporting needs via various applications, including specific review and claims-related portals.
• Work closely with the administrative assistant to ensure receipt and completeness of all review documentation.
• Develop materials such as forms, email correspondence, manuals, articles, lists, invoices, charts, matrices, reports, records, schedules, templates, and other documents of similar complexity.
• Organize and support team planning, arranging, and coordinating specific meetings, workshops, programs, presentations, conferences, or other group events.
• Utilize advanced computer skills for daily work; responsibilities require constant computer usage and proficiency in software programs such as Microsoft Office, all Windows software products, and web-based portals.
• Participate in portal development and enhancements, including testing and feedback to improve functionality and user experience.
• Adhere 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)).
• Complete other duties as assigned.

Qualifications

• Associate’s degree or five (5) years of related experience required; Bachelor’s degree preferred (healthcare specialty preferred).
• Minimum two (2) years of project support experience in a corporate or professional environment required.
• Experience in IDR or claims, appeal, and denial processes preferred.
• Project management skills required.
• Strong communication skills, both verbal and written, required.
• Strong multi-tasking skills with attention to detail and deadlines required.

Core Competencies

• Attention to detail
• Reliability
• Effective communication
• Collaboration
• Accountability
• Time management
• Problem-solving

Benefits

• 100% remote work flexibility
• Work/life balance
• Professional development and continuing education opportunities
• Medical, dental, vision, life insurance
• Short- and long-term disability
• Generous 401(k) match

Company Description

iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization, dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers.

Our mission is simple: help healthcare get better.