Houston, TX Start Date 01/06/2026
Salary Range $19.00 - $22.00 Hourly Position Type Full Time Job Shift Day
The Medical Billing / NSA / IDR Specialist processes out-of-network emergency claims under the No Surprises Act (NSA), with a primary focus on the Independent Dispute Resolution (IDR) process. This role is responsible for reviewing claims, preparing required documentation, and submitting cases accurately and on time to support appropriate reimbursement. Key duties include submitting open negotiations and IDR cases, following up with insurance carriers, mediators, and IDR entities, and resolving outstanding issues such as underpayments, missing information, or payment delays. The specialist maintains accurate records, updates internal tracking systems, and ensures that all work adheres to federal guidelines and internal procedures. The NSA/IDR Specialist is expected to communicate effectively, support team workflows, and help identify training needs, while consistently meeting daily, weekly, and monthly productivity goals.
Minimum Education: High School Diploma/G.E.D. Minimum 1 year of experience with insurance follow-up and NSA/IDR process. Understanding of in-network vs. out-of-network facility and physician claims Ability to read and interpret Explanations of Benefits (EOBs) Experience with commercial payers (UHC, Cigna, Aetna, BCBS, etc.) preferred Strong written and verbal communication skills Comfortable handling payer phone calls and follow-ups Basic proficiency with billing systems and Microsoft Excel/Word Ability to work independently and meet deadlines in a high-volume environment
JOB RESPONSIBILITIES/DUTIES
Manage the full lifecycle of Independent Dispute Resolution (IDR) cases, from initial open negotiation to final determination. Validate claims for NSA applicability and eligibility for the Federal or State IDR process. Prepare/review the accuracy of all NSA/IDR submissions, including payment offers, supporting documents, within strict federal and state deadlines. Track and document all IDR cases outcomes, payments, and administrative fee allocation. Track and follow up on additional receivables through the IDR process and the Mediation fee refund. Communicate with insurance carriers, IDR entities, and internal teams as needed. Maintain accurate logs and documentation in billing systems. Meet established productivity, accuracy, and timeliness expectations. Follow department workflows and compliance guidelines. Perform related duties as assigned by leadership
WORKING CONDITIONS
Frequent speaking, listening, using a headset, use of hands/fingers across keyboard or mouse, handling other objects, and long periods working at a computer. Service center with moderate noise level due to representatives talking, computers, printers, and floor activity. While performing duties of this job, the employee is frequently required to stand, walk, and sit. Must submit to random drug screenings.
Full-Time Benefit Perks:
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