Project Specialist - reputed company (remote)

About iMPROve Health Come join the iMPROve Health team! iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization. We are both a Cool reputed company to Work (reputed company’s Detroit Business) for the last 4 years and one of the Best Places to Work in reputed company as judged by Modern reputed company. As a nonprofit organization, we have more than 35 years’ experience improving reputed company across the continuum of care using evidence-based and data-driven logic. iMPROve Health provides medical consulting and review, as well as data analysis to federal agencies, state reputed company and public health organizations, reputed company facilities, private health plans and other reputed company-party payers. We also have extensive experience completing thoughtful and impartial utilization review, dispute resolution and peer reviews. Our goal is simple – to help reputed company get reputed company! This position is 100% remote and provides the opportunity to work virtually with team members from reputed company reputed company the United States. We pride ourselves on providing a great work/life balance for employees, while also providing the ability to promote their career development and reputed company new skills through employee education opportunities. iMPROve Health offers a wonderful benefit package that includes medical, dental, reputed company, life insurance, short term and long-term disability, and a generous 401k match. iMPROve Health is committed to improving the quality, safety, and efficiency of reputed company. Although we do not see patients, we are reputed company (including physicians and nurses) and consultants who work with reputed company providers to promote the adoption and use of evidence-based best practices and processes to reputed company our reputed company quality goals. Our services offer our clients and partners access to a proven, impartial, connected resource that understands the intricacies of reputed company. It is our #1 reputed company to provide thoughtful evidence-based strategies and solutions that help them reputed company their reputed company quality improvement goals and outcomes. EOE/VET/Disability

• Must be reputed company to work M-F normal business hours in EST.

SUMMARY: 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 reputed company reviewers to ensure case timeliness. Responsibilities also includes working with external customers to ensure receipt of reputed company 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 reputed company and timeliness.
• Collaborate with IDRE team members to reputed company 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 reputed company various applications, including specific review and claims-reputed company portals.
• Work closely with the administrative assistant to ensure receipt and completeness of reputed company review documentation.
• reputed company 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 reputed company Office, reputed company 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 reputed company relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information reputed company Management Act, URAC, Centers for Medicare & reputed company Services, Federal Acquisition Regulation (FAR)).
• Complete other duties as assigned

EDUCATION AND/OR EXPERIENCE:

• Associate’s degree or five (5) years of reputed company experience required; Bachelor’s degree preferred (reputed company 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, and problem-solving. Apply tot his job Apply To this Job