IDR Revenue Cycle Manager (Paralegal/Lawyer)

Overview

This role involves 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). The IDR Revenue Cycle Manager oversees the full lifecycle of eligible disputes, including claim and document review, eligibility assessment, deadline tracking, negotiation, IDR initiation, offer development, preparation of supporting arguments and evidence, determination review, and payment reconciliation.

The position requires experience in legal, claims, or regulatory compliance fields and strong skills in reviewing complex records, interpreting procedural requirements, preparing persuasive written submissions, managing strict filing deadlines, and developing dispute strategies based on case facts and financial value.

The IDR Revenue Cycle Manager serves as the primary strategic partner for assigned clients and collaborates closely with Billing, IDR Specialists, Revenue Cycle team members, Compliance, Legal resources, leadership, and clients to protect filing rights, strengthen dispute submissions, maximize lawful reimbursement opportunities, and ensure accurate and compliant case handling.

Responsibilities

IDR Case Strategy and Oversight

• Develop and manage monthly IDR and out-of-network dispute strategies for assigned clients.
• Review claims, correspondence, payment records, contracts, clinical documentation, and supporting materials to determine dispute eligibility.
• Assess cases based on procedural requirements, deadlines, evidence, payer behavior, reimbursement opportunity, financial value, and likelihood of favorable outcome.
• Oversee the full lifecycle of eligible matters from claim identification through final payment and reconciliation.
• Develop clear case theories and arguments supported by facts and documentation.
• Review and approve dispute offers, written statements, supporting documentation, and case submissions before filing.
• Escalate legally complex, high-risk, or precedent-setting cases to leadership, Compliance, or outside counsel.

Legal and Procedural Review

• Review applicable federal and state IDR procedures, notices, deadlines, filing requirements, and documentation standards.
• Interpret procedural rules and translate them into internal workflows and case requirements.
• Track negotiation periods, IDR initiation windows, response deadlines, payment deadlines, and other time-sensitive requirements.
• Ensure timely preparation and submission of all required notices, forms, statements, evidence, and supporting documents.
• Identify procedural deficiencies, inconsistencies, unsupported positions, or missing information.
• Maintain organized case files documenting history, strategy, evidence, communications, deadlines, and resolution.
• Coordinate with Compliance or legal counsel when formal legal interpretation or advice is required.

Case Preparation and Documentation

• Prepare clear, accurate, organized, and persuasive IDR submissions.
• Draft case summaries, factual narratives, negotiation positions, offer explanations, and responses to payer arguments.
• Compile supporting evidence such as claim forms, remittance advice, medical records, coding information, reimbursement data, provider credentials, patient acuity information, prior payment history, and relevant correspondence.
• Ensure evidence supports the position and reimbursement amount presented.
• Maintain detailed records of communications, filings, determinations, payments, and follow-up actions.
• Review documents for consistency, completeness, accuracy, and compliance before submission.
• Develop templates, checklists, evidence standards, and quality-control procedures for recurring dispute types.

Negotiation and Dispute Management

• Manage open-negotiation communications and settlement discussions with payers or their representatives.
• Develop negotiation positions based on case facts, evidence, reimbursement history, payer trends, costs, and financial value.
• Prepare and communicate settlement recommendations to clients and leadership.
• Evaluate settlement offers and determine appropriate next steps.
• Maintain professional, fact-based, and well-documented communications throughout the dispute process.
• Track negotiation and dispute outcomes to improve future case selection and submission strategy.

Revenue Cycle and Financial Oversight

• Maintain ownership of financial performance of assigned IDR and out-of-network portfolios.
• Review accounts receivable, collections, denials, underpayments, write-offs, reimbursement trends, dispute expenses, and aging.
• Identify revenue leakage, underpayment patterns, unresolved awards, and missed recovery opportunities.
• Coordinate with Billers, Revenue Cycle Managers, IDR Specialists, and Team Leads to resolve upstream issues.
• Verify that claims, coding, documentation, billing information, and payer responses support dispute positions.
• Monitor outstanding determinations, settlements, and unpaid awards through final resolution.
• Evaluate filing costs and administrative expenses relative to expected and actual financial recovery.
• Recommend case pursuit based on financial value, procedural strength, risk, and evidence.
• Ensure accurate recording and reconciliation of recoveries, settlements, fees, and adjustments.

Client Management

• Serve as primary point of contact for assigned clients regarding IDR matters and dispute performance.
• Explain procedural requirements, case risks, deadlines, documentation needs, and potential outcomes clearly.
• Establish realistic expectations regarding eligibility, timelines, settlement opportunities, expenses, and reimbursement.
• Provide clear reporting on dispute volume, case status, outcomes, recoveries, aging, risks, and required client actions.
• Communicate significant case developments, adverse determinations, procedural risks, and missed opportunities promptly.

Reporting and Analytics

• Track eligible and potentially eligible claims, claims reviewed, eligibility decisions, negotiation notices, responses, offers, counteroffers, settlements, IDR submissions, pending matters, determinations, dismissals, withdrawals, and payment status.
• Monitor win and settlement rates by payer, client, provider, procedure, dispute type, and case category.
• Track additional recovery amounts, filing fees, administrative and legal expenses, and other dispute-related costs.
• Analyze recurring payer positions, arguments, documentation requests, and determination patterns.
• Use case outcomes to improve evidence selection, written arguments, settlement positions, and filing strategies.
• Prepare accurate reports for clients, leadership, Compliance, and operational teams.

Compliance and Quality Assurance

• Maintain complete, accurate, confidential, and audit-ready documentation for every dispute.
• Monitor changes to IDR processes, filing requirements, documentation expectations, and procedural guidance.
• Ensure all submissions meet internal quality, evidence, documentation, and approval standards before filing.
• Conduct regular audits of active and closed cases.
• Identify missed deadlines, unsupported claims, inconsistent information, incomplete documentation, payment discrepancies, and process weaknesses.
• Develop corrective actions and prevention plans when issues are identified.
• Protect confidential, proprietary, financial, medical, and personally identifiable information.
• Ensure compliance with organizational policies and applicable privacy and security requirements.

Team Leadership and Development

• Coach IDR Specialists, Billers, and Revenue Cycle team members on eligibility, evidence collection, documentation standards, payer behavior, and dispute workflows.
• Establish clear ownership and accountability across every stage of the IDR process.
• Review team members’ case assessments, written submissions, documentation, and recommendations.
• Provide guidance on complex matters and assist with issue resolution and escalation.
• Develop team members to independently manage routine cases.
• Identify training and performance gaps and collaborate with Training Department on targeted education.
• Create and maintain standard operating procedures, case templates, submission guides, quality checklists, and reference materials.
• Provide feedback to improve legal writing, critical analysis, organization, accuracy, and deadline management.
• Promote a culture of accountability, confidentiality, professional judgment, and continuous improvement.

Qualifications

Required Experience

• Minimum of three years in roles such as paralegal, attorney, legal analyst, claims professional, legal operations specialist, regulatory specialist, or similar dispute-focused positions.
• Experience managing legal, administrative, insurance, healthcare, reimbursement, or financial disputes is strongly preferred.
• Demonstrated experience reviewing complex records and preparing written arguments, case summaries, demand letters, or submissions.
• Experience managing case files, evidence, correspondence, and strict procedural deadlines.
• Experience conducting legal, regulatory, or procedural research.
• Experience communicating with clients, opposing parties, insurance companies, government agencies, or other external stakeholders.
• Experience evaluating settlement positions, financial exposure, or dispute outcomes is preferred.
• Healthcare, medical billing, insurance claims, reimbursement, or revenue cycle experience is strongly preferred but may be learned by candidates with significant legal dispute experience.
• Previous experience supervising, coaching, or reviewing the work of paralegals, legal assistants, claims specialists, or operational team members is preferred.

Education

• Juris Doctor degree, or
• Bachelor’s degree in Legal Studies, Paralegal Studies, Business Administration, Healthcare Administration, Finance, or related field, or
• Associate degree or certificate in Paralegal Studies, or
• Equivalent combination of relevant education and professional legal or dispute-management experience.

Admission to a state bar may be preferred for positions requiring legal advice or functions reserved for licensed attorneys; however, active bar membership is not required when the role is structured as legal operations, case management, or paralegal under appropriate oversight.

Skills and Abilities

• Strong legal research, writing, document review, and case management skills.
• Ability to understand and apply detailed procedural requirements.
• Ability to prepare persuasive arguments supported by facts and documentation.
• Ability to manage strict and overlapping filing deadlines.
• Ability to review claims, remittance information, correspondence, and supporting records.
• Ability to identify inconsistencies, weaknesses, missing evidence, and procedural risks.
• Ability to prioritize cases by deadline, case strength, financial value, and recovery potential.
• Ability to develop negotiation, settlement, and dispute strategies.
• Ability to communicate confidently with clients, payers, leadership, and internal departments.
• Ability to maintain confidentiality and exercise appropriate professional judgment.
• Ability to work independently while recognizing when escalation or legal review is necessary.
• Ability to organize large volumes of information and maintain accurate case files.
• Ability to coach team members and improve case preparation quality.
• Ability to analyze case outcomes, payer behavior, reimbursement trends, and financial performance.
• Strong critical-thinking, problem-solving, and decision-making skills.
• Proficiency in Microsoft Word, Excel, Outlook, and related business applications.
• Ability to learn and effectively use new claims platforms, document systems, dispute portals, and reporting tools.

Key Performance Indicators

• Timely filing rate of 98% or higher.
• Review of 100% of identified potentially eligible claims.
• Client reports delivered 100% on time.
• Documentation accuracy maintained at 95% or higher.
• Missed deadline rate maintained below 2%.
• IDR win and settlement rates tracked by payer and client.
• Additional dollars recovered tracked monthly and year to date.
• Average additional recovery per case tracked monthly.
• Outstanding determinations and unpaid awards monitored at 30, 60, and 90+ days.
• IDR filing and administrative expense-to-recovery ratio tracked monthly.
• Reduction in cases dismissed due to incomplete, inaccurate, or untimely submissions.
• Reduction in missed, expired, or unsupported dispute opportunities.
• Improvement in submission quality and routine-case independence among IDR team members.

Location

Remote work environment with collaboration across teams and clients.