[Hiring] IDRE Quality Specialist @North Haven Solutions

Role Description

North Haven Government Services Solutions is seeking a skilled and detail-oriented IDRE QA Specialist to join our growing Operations team. This is an important role within our Independent Dispute Resolution (IDR) process, ensuring the accuracy, completeness, and timely delivery of reports to the Centers for Medicare & Medicaid Services (CMS).

The QA Specialist serves as a key point of coordination between customers, reviewers, and management, helping ensure that each completed reviewer report meets established requirements and is delivered within required timeframes.

Qualifications

• Highly organized and detail-oriented
• Able to manage multiple priorities in a deadline-driven environment
• Strong communication skills
• Sound judgment and problem-solving abilities
• Commitment to accuracy

Requirements

• Review reviewer reports for accuracy, completeness, and adherence to customer requirements, company standards, and applicable clinical guidelines
• Coordinate and communicate effectively with customers, reviewers, and management to resolve questions, address deficiencies, and facilitate timely report completion
• Ensure reports meet established quality standards and are submitted to CMS within required deadlines
• Identify discrepancies, missing information, and opportunities for improvement throughout the review process
• Maintain a strong understanding of company processes, quality expectations, and applicable IDRE requirements
• Contribute to continuous process improvement initiatives designed to enhance quality, efficiency, and turnaround times
• Work collaboratively with the Operations team to support the company's continued growth and operational success
• Evaluate the quality of the dispute rationale/determination to ensure that all requirements have been met in compliance with internal and CMS guidelines
• Follow up with the arbiters for any pertinent and missing information
• Assess whether the rationale is logical and the conclusions are based on sound assumptions
• Maintain professionalism and courtesy when responding to emails and other communications, ensuring all communications involving HIPAA and PHI are handled appropriately, securely, and in accordance with applicable privacy and confidentiality requirements

Benefits

• Comprehensive benefits package designed to support well-being and peace of mind
• Medical, dental, and vision coverage for you and your family
• Voluntary life insurance options for you, your spouse, and your children
• Other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans
• Basic life insurance, short-term disability, and long-term disability coverage at no cost
• Generous paid time off policy
• 401k plan with a company match
• Apple equipment and a media stipend for remote workspace

Company Description

Dane Street’s Government Services Division provides specialized, compliant solutions that support federal and state program needs with efficiency, accuracy, and integrity. Through services such as Independent Dispute Resolution (IDR), North Haven partners with organizations to deliver clear outcomes that meet both operational and clinical standards. We serve as a trusted resource, bringing clarity, consistency, and confidence to complex review processes.