U.S. citizen or authorized to work in the U.S., with at least three years of verifiable U.S. residency in the last five years
Ability to obtain and maintain a Public Trust Government Clearance
NO THIRD PARTY RECRUITERS.
We are seeking a Technical (Case) Analyst to join our client's team.
The federal Independent Dispute Resolution (IDR) process plays a critical role in resolving eligible out-of-network payment discrepancies between providers, facilities and health plans under the No Surprises Act. As part of a multidisciplinary team, the Technical (Case) Analyst will support this mission by conducting detailed reviews of medical and billing documentation, evaluating information from involved parties and contributing to efficient, accurate and compliant case outcomes.
Responsibilities
Access and review disputes in the Federal IDR Portal.
Conduct case file reviews across multiple government and IDRE systems and databases, applying prior medical record and/or case management experience.
Assess cases and develop findings to support eligibility determinations and other dispute-related decisions, while consistently meeting productivity, quality and timeliness standards for triaging and resolving open disputes.
Identify gaps in documentation and materials by reviewing case files for incomplete, unclear, or missing information and initiate appropriate follow-up actions.
Recommend improvements to business processes, workflows and case intake and management practices through contribution and development of guidance materials, including training resources, job aids and operational documentation.
Collect and synthesize data from multiple sources, including web-based systems, client databases and other authorized systems
Minimum Qualifications
U.S. citizen or authorized to work in the U.S., with at least three years of verifiable U.S. residency in the last five years.
Ability to obtain and maintain a Public Trust Government Clearance
High school diploma, or equivalent. Bachelor’s degree in healthcare administration, public policy, public health or related field preferred.
2 or more years of relevant experience in medical record case management, benefits or eligibility processing, health program operations, or similar high-volume, process-driven environments.
Experience with case management systems, CRM platforms, or similar data tools
Detail-oriented with the ability to manage moderate to high case volumes, follow structured workflows and apply sound judgment.
Effective written and verbal communication skills, with the ability to convey information clearly and professionally across stakeholders.
Willingness to report to the Woodlawn, MD headquarters, or other designated location, to engage in project-related activities. Required attendance may occur at regular intervals and span multiple days (typically two).
Preferred
Experience supporting federal or state health programs (e.g., CMS, Medicaid, Medicare)
Familiarity with HIPAA and federal data handling requirements
Experience working in regulated, audit-driven environments
Please Note:
Only those individuals selected for an interview will be contacted.
No calls, inquiries, or Third-Party Vendors please.
We are an equal opportunity employer. We encourage applications from candidates of all backgrounds and experiences. (The ACI Group is unable to sponsor H1B Visas).
$1000 Referral Bonus - www.aci.com.
Since 1988, The ACI Group, a Baltimore-based staffing firm, has been committed to hiring the industry's leading professionals, and presenting exciting career opportunities. We have access to varied types of contract, permanent and contract-to-perm positions and offer a choice of employment options including a full benefits package.
Numbers & Facts
Location
Baltimore, Maryland
Skills
Analysis Skillsunmatched
Billing Recordsunmatched
Case Managementunmatched
Centers for Medicare and Medicaid Services (CMS)unmatched
Communication Skillsunmatched
Compensation and Benefitsunmatched
Consultingunmatched
Cross-Functionalunmatched
Customer Relationship Management (CRM)unmatched
Data Collectionunmatched
Detail Orientedunmatched
Documentationunmatched
Facilities Planningunmatched
Governmentunmatched
HIPAA (Health Insurance Portability and Accountability Act)unmatched
Health Planunmatched
Healthcare Administrationunmatched
High School Diplomaunmatched
Medicaidunmatched
Medical Billingunmatched
Medical Recordsunmatched
Medicareunmatched
Presentation/Verbal Skillsunmatched
Process Improvementunmatched
Public Healthunmatched
Public Policyunmatched
Reconciliationunmatched
Security Clearanceunmatched
United States Citizenunmatched
Writing Skillsunmatched
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