[Hiring] Payment Determinations Coordinator @MICHIGAN PEER REVIEW ORGANIZATION

Role Description

iMPROve Health is seeking a detail-oriented, organized, and experienced Payment Determinations Coordinator to support our Federal and State Independent Dispute Resolution Entity (IDRE) programs under the No Surprises Act (NSA).

In this role, you will:

• Coordinate payment determination activities.
• Manage dispute cases and program deadlines.
• Maintain accurate case records.
• Support compliance with applicable Centers for Medicare & Medicaid Services (CMS) requirements and contractual obligations.
• Work closely with arbitrators, program managers, and organizational leadership to facilitate timely, accurate, and consistent case processing.

The ideal candidate has a strong understanding of the Federal No Surprises Act, excellent project and time management skills, and the ability to navigate multiple electronic systems while managing competing priorities in a fully remote environment.

Qualifications

• Bachelor’s degree in a healthcare-related field or equivalent relevant experience.
• At least five years of project support experience in a corporate or professional environment, with a demonstrated ability to meet deadlines.
• Knowledge of the Federal No Surprises Act.
• Strong organizational, project management, and time management skills.
• Excellent written and verbal communication skills.
• Strong attention to detail, reliability, accountability, and problem-solving skills.
• Ability to manage multiple priorities, work independently, and meet deadlines in a fast-paced environment.
• Ability to handle confidential and sensitive information appropriately.
• Proficiency with Microsoft Office applications, Windows-based software, and web-based portals.
• Experience developing and maintaining moderately complex spreadsheets.
• Ability to navigate multiple electronic systems and cloud-based platforms while maintaining accurate records and data integrity.
• Ability to collaborate effectively with internal teams and external stakeholders.

Requirements

• Coordinate dispute cases throughout the case lifecycle, from intake through final resolution.
• Review case submissions for completeness, accuracy, eligibility, and compliance with applicable program requirements.
• Coordinate case assignments to arbitrators, reviewers, and other appropriate decision-makers.
• Complete payment determination processing following arbitrator review in accordance with established procedures and program requirements.
• Monitor case status, deadlines, and outstanding activities to ensure timely resolution.
• Maintain accurate case information, documentation, and communications in CMS portals and internal databases.
• Respond to arbitrator inquiries and provide procedural guidance regarding case requirements and workflows.
• Complete assigned contract deliverables and operational activities within established timelines.
• Monitor work plans, schedules, and case-processing activities to identify potential delays, risks, or operational issues.
• Ensure compliance with applicable CMS requirements, HIPAA, FISMA, URAC standards, contractual obligations, and internal policies.
• Conduct quality reviews to promote accuracy, consistency, and adherence to established procedures.
• Identify discrepancies, compliance concerns, and opportunities for process improvement, escalating issues as appropriate.
• Assist with the implementation and enhancement of operational systems, tools, and workflows.
• Develop, update, and maintain standard operating procedures (SOPs), job aids, templates, FAQs, troubleshooting guides, and other operational resources.
• Develop and deliver onboarding and ongoing training related to IDRE workflows, CMS portal navigation, documentation standards, and communication protocols.
• Collaborate with program managers and leadership to ensure training materials reflect current regulatory guidance, contractual requirements, and internal policies.
• Conduct refresher training and assist in identifying knowledge gaps and additional training needs.
• Communicate process changes and updates to affected team members.
• Coordinate with internal teams and external stakeholders, including arbitrators, providers, payers, legal representatives, and other dispute resolution participants.
• Serve as a point of contact for procedural questions, submission requirements, and case status inquiries.
• Maintain neutral, professional, and clear communication throughout the dispute resolution process.
• Collaborate with operations, compliance, legal, finance, IT, and other teams to resolve issues and support program objectives.
• Participate in meetings concerning operational priorities, escalations, stakeholder feedback, and policy updates.
• Prepare operational reports related to case volume, resolution outcomes, turnaround times, outreach activities, and performance metrics.
• Maintain spreadsheets, tracking tools, and dashboards to monitor service levels, response times, case aging, and operational trends.
• Analyze operational data and stakeholder feedback to identify opportunities to improve efficiency, accuracy, and service delivery.
• Support special projects and other duties as assigned.

Benefits

• Fully remote work environment.
• Flexibility to work from anywhere in the United States.
• Prioritization of work/life balance.
• Investment in professional development and continuing education opportunities.

Remote Work Requirements

• Maintain a reliable high-speed internet connection suitable for business applications and virtual communications.
• Maintain a private, secure, professional, and distraction-free workspace.
• Protect confidential information, including protected health information (PHI), in accordance with HIPAA, FISMA, URAC, CMS, and organizational requirements.
• Work independently, manage competing priorities, and consistently meet established deadlines.
• Maintain regular availability and communication during scheduled work hours.
• Effectively collaborate through virtual meetings, approved communication tools, and electronic systems.