No Surprises Act / Federal IDR Medical Claims Appeals Specialist

REQUIRED EXPERIENCE — PLEASE READ BEFORE APPLYING Do not apply unless you have direct experience with No Surprises Act / federal IDR, provider dispute resolution, or out-of-network payer appeals. This project requires knowledge of open negotiation, IDR eligibility, EOB review, QPA/payment data, payer underpayment disputes, and deadline-sensitive claims workflows. We are not hiring for routine medical billing, charge entry, payment posting, patient collections, or generic virtual assistance. Applicants must describe their specific IDR/NSA or out-of-network appeals experience in the first paragraph of the application. Generic applications will be declined. Surgery practice seeking an experienced medical billing appeals / denials specialist to help build an internal workflow for No Surprises Act / federal Independent Dispute Resolution claims. This is not routine billing. We are not looking for charge entry, payment posting, or patient billing. We need someone who can review underpaid out-of-network surgical claims, read EOBs, organize claim data, identify missing documents, track deadlines, and prepare open negotiation / IDR-ready materials. Initial project will use redacted claim documents only. No unredacted PHI will be provided during the pilot. For the pilot, we will provide redacted materials for up to 5 surgical claims. Contractor will prepare: 1. Claim timeline 2. Federal IDR eligibility concerns 3. CPT/payment/QPA table 4. Missing-document checklist 5. Draft open negotiation letter 6. Preliminary IDR packet outline 7. Master tracking spreadsheet Preferred experience: * Medical billing denials and appeals * Out-of-network reimbursement * No Surprises Act / federal IDR * Provider dispute resolution * Surgical, anesthesia, ER, radiology, hospital, or complex claims * EOB and payer correspondence review * Excel / Google Sheets * HIPAA-sensitive workflows * Strong writing and deadline discipline Do not apply if your experience is limited to routine office billing, charge entry, payment posting, or patient balance collections. Please answer these questions in your application: 1. What is your experience with No Surprises Act or federal IDR? 2. What is the difference between a payer appeal, open negotiation, and IDR? 3. What information do you need from an EOB to calculate IDR deadlines? 4. Have you worked with out-of-network surgical, anesthesia, ER, radiology, or hospital claims? 5. Have you built or managed a denials/appeals workflow before? 6. Are you comfortable starting with redacted documents only? Project will be milestone-based. Initial paid test claim will be $250. If the work is accurate and useful, we will proceed with the full pilot and possible ongoing part-time support. Suggested Upwork Milestones Milestone 1 — Test Claim Review Budget: $250 Due: 3–5 days after receiving redacted documents Deliverables for 1 redacted claim: * Claim timeline * EOB/payment summary * CPT/payment/QPA table * Missing-document checklist * Federal IDR eligibility concerns * Draft open negotiation letter * Short note on whether the claim appears worth pursuing Purpose: Prove the contractor can read the materials and think clearly before expanding the project. ⸻ Milestone 2 — Five-Claim Pilot Budget: $1,000 Due: 7–10 days after Milestone 1 approval Deliverables for up to 5 redacted claims: * One claim memo per claim * Claim timeline per claim * CPT/payment/QPA table per claim * Missing-document checklist per claim * Draft open negotiation letter per claim * Preliminary IDR packet outline per claim * Eligibility concerns per claim * Batching considerations, if any Purpose: Build the core IDR review workflow and test whether the contractor can handle multiple claims without losing details. ⸻ Milestone 3 — Master Tracker + Workflow Templates Budget: $250 Due: 5–7 days after Milestone 2 approval Deliverables: * Master IDR tracking spreadsheet * Open negotiation template * IDR packet outline template * Missing-document checklist template * Deadline tracking fields * Recommended internal workflow/SOP * Suggested next steps for bringing clean claims in-house Purpose: Turn the pilot into a reusable internal process. ⸻ Total Fixed Budget $1,500 Upwork Milestone Entry Version Milestone 1: Test Claim Review — $250 Review 1 redacted surgical claim and provide a timeline, CPT/payment/QPA table, missing-document checklist, eligibility concerns, and draft open negotiation letter. Milestone 2: Five-Claim Pilot — $1,000 Review up to 5 redacted surgical claims and prepare claim memos, timelines, CPT/payment/QPA tables, missing-document checklists, draft open negotiation letters, preliminary IDR packet outlines, and batching/eligibility concerns. Milestone 3: Tracker and Workflow Buildout — $250 Create a master IDR tracking spreadsheet, reusable templates, deadline fields, missing-document checklist, and recommended internal SOP/workflow.