Health Insurance Specialist 259457

Health Insurance Specialist – UM RN / Appeals RN / CPC / Healthcare Arbitrator Client: Independent Dispute Resolution Entity (IDRE) Work Arrangement: Fully Remote Schedule: Monday–Friday, 8:00 a.m.–5:00 p.m. Eastern Time Pay Range: $25.00–$40.00 per hour; flexible based on candidate caliber and experience Equipment: Provided by client Potential Start Dates: November 2, 2026, and November 16, 2026 Employment Type: Contract, with strong potential for permanent conversion Required Experience Candidates should have a background aligned with at least one of the following areas: Utilization Management Registered Nurses (UM RNs): Experience reviewing clinical documentation, applying medical necessity criteria, evaluating healthcare services, or making utilization-related determinations. Appeals Registered Nurses: Experience reviewing appealed claims or healthcare decisions, analyzing documentation, applying coverage or clinical guidelines, and writing appeal rationales. AAPC-Certified Medical Coders: Medical coding with an active AAPC certification. Healthcare arbitration or healthcare dispute resolution. POSITION OVERVIEW We are seeking experienced healthcare professionals to join a growing Independent Dispute Resolution (IDR) program supporting payment dispute resolution under the federal No Surprises Act. This opportunity is ideal for Utilization Management Registered Nurses (UM RNs), Appeals RNs, AAPC-certified medical coders, and healthcare arbitrators who have strong analytical skills, sound judgment, and excellent written communication abilities. In this role, you will review healthcare payment disputes, evaluate documentation from providers and health plans, make independent determinations, and draft formal determination letters explaining your decisions. The ideal candidate combines attention to detail with the ability to manage high case volumes while maintaining accuracy, efficiency, and quality. KEY RESPONSIBILITIES Review and analyze payment disputes between nonparticipating healthcare providers and group health plans under the No Surprises Act. Evaluate medical records, claims documentation, EOBs, provider submissions, payer responses, and supporting evidence. Apply relevant regulatory requirements, coding knowledge, clinical judgment, and dispute-resolution principles to assess cases. Analyze competing payment offers and make independent determinations in accordance with applicable IDR requirements. Draft clear, accurate, and well-supported determination letters explaining the decision and its rationale. Identify relevant facts, reconcile conflicting information, and document the reasoning behind each determination. Complete case documentation and data entry accurately and within established deadlines. Report determinations through designated government portals and systems. Maintain impartiality, confidentiality, regulatory compliance, and applicable conflict-of-interest standards.