The Role
Own end-to-end federal and state IDR disputes: manage eligibility, open negotiation, batching, CMS portal filings, written submissions, offer selection, and post-determination reconciliation. Analyze QPAs, gather supplemental evidence, negotiate with payers, adapt to state rules, and improve playbooks. Senior specialists also review complex disputes and mentor teammates.
Summary Generated by Built In
About Clearest Health
The Role
What You'll Do
Clearest Health helps providers get paid fairly for out-of-network care. We turn the No Surprises Act (NSA) from a compliance burden into a recovery engine — combining deep regulatory expertise with technology that automates the slow, paperwork-heavy parts of the federal and state IDR processes. Every dispute we win puts revenue back into the hands of clinicians who earned it.
We're hiring Dispute Specialists at both the Specialist and Senior Specialist levels to own end-to-end Independent Dispute Resolution (IDR) cases. You'll work claims from initial open negotiation through final IDRE determination, build defensible offers grounded in QPA and supplemental information, and represent Clearest Health's clients in front of certified IDR entities. This role is for someone who is already familiar with the federal IDR portal and ready to operate at scale.
We support a hybrid schedule — most weeks include two to three days in office, with remote days for focused submission work.
- Manage a portfolio of federal NSA IDR disputes from eligibility review through IDRE determination, owning every step: open negotiation outreach, IDR initiation, batching decisions, written submissions, offer selection, and post-determination reconciliation.
- Build the strongest possible case for each dispute by analyzing the QPA, gathering supplemental information (provider training, complexity, market data, acuity, prior contracted rates, comparable case data), and crafting clear, well-cited written narratives that IDREs find persuasive.
- Conduct open negotiations directly with commercial payers — making and countering offers, escalating where appropriate, and closing disputes pre-IDR when the math favors it.
- Make batching and bundling judgment calls that maximize win rate and minimize administrative fees, while staying within CMS guidance on what qualifies.
- File and track cases through the CMS Federal IDR portal with near-zero error rate on deadlines, eligibility, and procedural requirements.
- Handle state-level IDR programs (Texas, New York, Georgia, and others as the team expands) — adapting your approach to each state's rules, timelines, and evidentiary expectations.
- Track outcomes, root-cause losses, and feed learnings back into our playbooks, templates, and product roadmap.
- (Senior level) Serve as a technical reviewer on complex or high-dollar disputes, mentor newer specialists, and partner with engineering and operations to improve our internal tooling.
Required
- 3+ years (Specialist) or 5+ years (Senior) of hands-on IDR experience filing federal NSA disputes through the CMS Federal IDR portal — not adjacent revenue cycle work, actual IDR case ownership.
- Strong working knowledge of the No Surprises Act, QPA methodology, and the additional information factors IDREs weigh under 45 CFR § 149.510.
- Demonstrated ability to analyze a QPA — spot whether it's reasonable, identify the supplemental factors that justify a higher offer, and build a quantitative case for your number.
- Proven track record negotiating with commercial payers (UnitedHealthcare, Anthem/Elevance, Aetna, Cigna, BCBS plans) during open negotiation, with examples of disputes you've closed pre-IDR.
- Experience with batching strategy and the procedural rules around batched and bundled disputes.
- Familiarity with at least one state IDR program (Texas SB 1264, New York's IDR process, Georgia, New Jersey, or similar) and an appetite to learn the others.
- Exceptional written communication — your IDR submissions need to read like a tight legal brief, not a form letter.
- Comfort working in spreadsheets and dispute-management tooling; you can pull a pivot, spot an outlier in a batch, and explain a number to a non-finance audience.
Nice to have
- Background in provider-side revenue cycle, payer contracting, or healthcare claims appeals.
- Experience in a specific specialty where IDR volume is heavy (emergency medicine, anesthesiology, radiology, pathology, air ambulance).
- Paralegal, legal-ops, or compliance experience in healthcare.
- Familiarity with the CMS public IDR data and how to use prior determinations as supporting evidence.
- You'll work on disputes that materially change whether a physician group makes payroll. The impact is direct and measurable.
- You'll be supported by a tech stack that automates the parts of IDR that should be automated — so your time goes to the judgment calls that actually move outcomes, not to portal data entry.
- Competitive base salary plus performance bonus tied to recovery, comprehensive medical/dental/vision, 401(k) match, and meaningful equity.
- A small, senior team where your wins are visible and your playbook ideas ship.
Skills Required
- 3+ years (Specialist) or 5+ years (Senior) of hands-on IDR experience filing federal NSA disputes through the CMS Federal IDR portal
- Strong working knowledge of the No Surprises Act, QPA methodology, and additional information factors under 45 CFR § 149.510
- Demonstrated ability to analyze a QPA, identify when it’s reasonable, and build a quantitative case for a higher offer
- Proven track record negotiating with commercial payers during open negotiation, with examples of disputes closed pre-IDR
- Experience with batching strategy and procedural rules around batched and bundled disputes
- Familiarity with at least one state IDR program (eg Texas SB 1264, New York, Georgia) and willingness to learn others
- Exceptional written communication; ability to craft concise, well-cited IDR submissions
- Comfort working in spreadsheets and dispute-management tooling (able to pull pivots, spot outliers, explain numbers)
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The Company
What We Do
Clearest Health is an AI-enabled revenue recovery platform that helps independent healthcare practices recover out-of-network revenue through IDR appeals under the No Surprises Act. By utilizing verified benchmarks and AI-powered risk scoring, the company provides tools to maximize the recovery of underpaid healthcare claims, aiming to level the playing field for independent medical providers against insurance companies.
