Qureos Mentor

Sarnova HC, LLC

The Sarnova Family of companies includes Digitech Computer, Bound Tree Medical, Tri-anim Health Services, Cardio Partners, and Emergency Medical Products
 
Digitech is a leading provider of advanced billing and technology services to the EMS transport industry. Since its founding in 1984, Digitech has refined its software platform to create a cloud-based billing and business intelligence solution that monitors and automates the entire EMS revenue lifecycle. Digitech leverages its proprietary technology to offer fully outsourced services that maximize collections, protect compliance, and deliver results for clients.
 
Summary: 
The NSA & IDR Reimbursement Specialist is responsible for managing the No Surprises Act (NSA) reimbursement process for out-of-network air ambulance claims. This position reviews payer reimbursement determinations, identifies claims eligible for Open Negotiation and Independent Dispute Resolution (IDR), and manages cases through final resolution to maximize reimbursement and ensure regulatory compliance.
 The ideal candidate possesses strong analytical skills, knowledge of healthcare reimbursement processes, and the ability to manage multiple deadlines in a fast-paced environment.
 
Essential Duties and Responsibilities: 
<ul>
<li>Review out-of-network air ambulance claims to determine eligibility under the No Surprises Act.</li>
<li>Analyze payer reimbursement determinations and identify underpayment opportunities.</li>
<li>Initiate and manage Open Negotiation requests within federal regulatory timelines.</li>
<li>Prepare, submit, and track Independent Dispute Resolution (IDR) cases through the federal IDR portal.</li>
<li>Gather and organize supporting documentation, reimbursement data, and case narratives for dispute submissions.</li>
<li>Communicate directly with insurance carriers, third-party administrators, and other stakeholders regarding payment disputes and reimbursement negotiations.</li>
<li>Monitor all NSA and IDR deadlines to ensure timely filings and compliance.</li>
<li>Coordinate administrative and arbitrator fee payments associated with IDR cases.</li>
<li>Track IDR determinations and ensure payers comply with awarded reimbursement amounts.</li>
<li>Escalate unresolved payment issues and payer non-compliance when appropriate.</li>
<li>Maintain accurate records of negotiations, submissions, determinations, and collections.</li>
<li>Prepare reports related to NSA activity, reimbursement recoveries, payer trends, and dispute outcomes.</li>
<li>Monitor regulatory updates and payer policy changes affecting air ambulance reimbursement.</li>
<li>Collaborate with billing, accounts receivable, compliance, legal, and operational teams to resolve claim issues and improve reimbursement outcomes.</li>
</ul>
Skills/Experience Required: 
<ul>
<li>High School Diploma or equivalent required; Associate degree preferred.</li>
<li>Minimum of 2 years of experience in healthcare claims processing, billing, accounts receivable, appeals, payer relations, or reimbursement recovery.</li>
<li>Hands-on experience preparing and submitting insurance appeals, including understanding payer denial codes and timely filing limits.</li>
<li>Experience working with commercial insurance payers.</li>
<li>Familiarity with ICD-10, HCPCS, and general medical terminology.</li>
<li>Proficiency with various web platforms including billing software and payer portals.</li>
<li>Excellent computer skills including Microsoft Word, Excel, and Outlook.</li>
<li>Strong verbal and written communication skills.</li>
<li>Strong interpersonal, organizational, and time management skills.</li>
<li>Strong problem-solving, investigative, critical thinking, and analytical skills.</li>
<li>Ability to manage multiple priorities, meet strict deadlines, and work in a fast-paced environment with minimal supervision.</li>
<li>Prior customer service experience with the ability to collaborate across departments and teams.</li>
<li>Ability to independently manage all aspects of the role, including productivity goals and business practices in a remote environment.</li>
</ul>
Preferred Experience: 
<ul>
<li>EMS, air ambulance, healthcare transportation, or medical billing experience.</li>
<li>Knowledge of the No Surprises Act (NSA) and Federal Independent Dispute Resolution (IDR) process.</li>
<li>Experience with payer appeals, arbitration, negotiations, reimbursement recovery, or dispute resolution.</li>
<li>Knowledge of healthcare reimbursement methodologies and payer contracting concepts.</li>
<li>Experience working with federal or state healthcare regulations.</li>
<li>Collections experience.</li>
</ul>
Sarnova is an Equal Opportunity Employer. We offer a competitive salary, commensurate with experience, along with a comprehensive benefits package, including 401(k) Plan. EO/M/F/Veterans/Disabled.
 Our mission is to be the best partner for those who save and improve patients’ lives. Excellence in delivering upon our mission is dependent upon having a diverse team that is empowered to bring their full, authentic self to work each day. We strive to create a workplace that reflects the communities we serve, and we are passionate about creating an inclusive workplace that promotes and values diversity.
 #digitech

NSA & IDR Reimbursement Specialist - Digitech - Remote

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Sarnova HC, LLC

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NSA & IDR Reimbursement Specialist - Digitech - Remote