IDR Revenue Cycle Manager (Paralegal/Lawyer)

About The Auctus Group LLC

Who we are: We’re big on people and culture at the Auctus Group. Our most important role as a company is to provide an amazing working environment for our team. We’ve been work-from-home-warriors since before it was cool. We support (like encourage and fund) continuing education. We match charitable donations. Our whole goal is: work to live not live to work . Oh and we’re weirdos too…we do remote happy hours and have a book club and goofy stuff like that.

Who we’re looking for: Smart, talented, tech-savvy, experienced, go-getter types. You’ll do well if:

- you like a fast-paced environment,

- you thrive with change and development,

- you like giving feedback,

- you’re a team player,

- you love learning/sleuthing,

- you’re big on accountability.

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.

The ideal candidate has experience as a paralegal, attorney, legal operations professional, claims specialist, or regulatory compliance professional. This individual must be 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.

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. The position is responsible for protecting filing rights, strengthening dispute submissions, maximizing lawful reimbursement opportunities, and ensuring that all cases are handled accurately and within applicable requirements.
ESSENTIAL FUNCTIONS

The IDR Revenue Cycle Manager’s responsibilities include, but are not limited to, the following:
IDR CASE STRATEGY AND OVERSIGHT

- 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.

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 clear internal workf