Determinations Coordinator - Idre - Remote

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IDRE - TEAM 3 FTE 1.0 Professional Lansing, MI, US

3 days ago Requisition

Salary Range: $60,000.00 To $70,000.00 Annually

About iMPROve Health

Come join the iMPROve Health team!

iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization, and we’re proud to be recognized as both a Cool Place to Work by Crain’s Detroit Business (four years running) and one of Modern Healthcare’s Best Places to Work in Healthcare.

As a nonprofit with more than 40 years of experience, we’re dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers. Our team also specializes in impartial utilization review, dispute resolution, and peer review.

Our mission is simple: help healthcare get better.

This position is 100% remote, offering the flexibility to work from anywhere in the United States while collaborating with a supportive, nationwide team. We prioritize work/life balance and invest in our employees’ growth through professional development and continuing education opportunities.

At iMPROve Health, we are committed to improving the quality, safety, and efficiency of healthcare. While we do not provide direct patient care, our healthcare professionals—including physicians, nurses, and experienced consultants—partner with providers to promote the use of evidence-based best practices. We offer our clients a trusted, impartial resource that understands the complexities of the healthcare landscape and is dedicated to thoughtful, high-quality solutions.

Join us in making a meaningful impact on healthcare—one improvement at a time.

Payment Determinations Coordinator | Fully Remote

About the Role

iMPROve Health is seeking a detail-oriented, organized, and experienced Payment Determinations Coordinator to support our Federal and State Independent Dispute Resolution Entity (IDRE) programs under the No Surprises Act (NSA).

In this role, you will coordinate payment determination activities, manage dispute cases and program deadlines, maintain accurate case records, and support compliance with applicable Centers for Medicare & Medicaid Services (CMS) requirements and contractual obligations. You will work closely with arbitrators, program managers, and organizational leadership to facilitate timely, accurate, and consistent case processing.

The ideal candidate has a strong understanding of the Federal No Surprises Act, excellent project and time management skills, and the ability to navigate multiple electronic systems while managing competing priorities in a fully remote environment.

Key Responsibilities

Payment Determinations and Case Management

• Coordinate dispute cases throughout the case lifecycle, from intake through final resolution.
• Review case submissions for completeness, accuracy, eligibility, and compliance with applicable program requirements.
• Coordinate case assignments to arbitrators, reviewers, and other appropriate decision-makers.
• Complete payment determination processing following arbitrator review in accordance with established procedures and program requirements.
• Monitor case status, deadlines, and outstanding activities to ensure timely resolution.
• Maintain accurate case information, documentation, and communications in CMS portals and internal databases.
• Respond to arbitrator inquiries and provide procedural…