IDR Revenue Cycle Manager (Paralegal/Lawyer)

About the Role

The IDR Revenue Cycle Manager is responsible for managing the strategy, documentation, procedural compliance, and financial performance of out-of-network claims that may qualify for open negotiation and Independent Dispute Resolution (IDR). This role oversees the full lifecycle of eligible disputes, including claim and document review, eligibility assessment, deadline tracking, open negotiation, IDR initiation, offer development, preparation of supporting arguments and evidence, determination review, and payment reconciliation.

Responsibilities

• Develop and manage a monthly IDR and out-of-network dispute strategy for each assigned client.
• Review claims, correspondence, payment records, remittance information, contracts, clinical documentation, and supporting materials to determine potential dispute eligibility.
• Assess cases based on procedural requirements, filing deadlines, available evidence, payer behavior, reimbursement opportunity, financial value, and likelihood of a favorable outcome.
• Oversee the full lifecycle of each eligible matter, from claim identification and open negotiation through IDR submission, determination, settlement, and final payment.
• Develop clear case theories and arguments based on the facts, documentation, reimbursement history, and applicable procedural requirements.
• Review and approve dispute offers, written statements, supporting documentation, exhibits, and case submissions before filing.
• Ensure that all representations made in dispute submissions are accurate, supported, and consistent with available records.
• Determine when additional information, documentation, or subject-matter review is required before proceeding.
• Escalate legally complex, high-risk, high-value, unusual, or precedent-setting cases to leadership, Compliance, or outside legal counsel.
• Ensure that favorable determinations and settlements are pursued through final payment and reconciliation.

Requirements

• Experience as a paralegal, attorney, legal operations professional, claims specialist, or regulatory compliance professional.
• Comfortable reviewing complex records, interpreting procedural requirements, preparing persuasive written submissions, managing strict filing deadlines, and developing dispute strategies based on the facts and financial value of each case.
• Ability to work in a fast-paced environment, thrive with change and development, and give feedback.
• Team player with a strong emphasis on accountability.
• Strong analytical and problem-solving skills, with the ability to learn and adapt quickly.

Skills

• Strong legal and procedural analysis skills.
• Ability to review complex facts and documentation to determine potential dispute eligibility.
• Excellent written and verbal communication skills, with the ability to prepare clear and persuasive written submissions.
• Strong organizational and time management skills, with the ability to manage multiple cases and deadlines simultaneously.
• Ability to work independently and as part of a team, with a strong emphasis on collaboration and communication.