iMPROve Health

Title:Administrative Assistant Location: United States Job Description: About iMPROve Health Come join the iMPROve Health team! iMPROve Health is Michigan's Medicare-designated Quality Improvement Organization, and we're proud to be recognized as both a Cool Place to Work by Crain's Detroit Business (four years running) and one of Modern Healthcare's Best Places to Work in Healthcare. As a nonprofit with more than 40 years of experience, we're dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers. Our team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: help healthcare get better. This position is 100% remote, offering the flexibility to work from anywhere in the United States while collaborating with a supportive, nationwide team. We prioritize work/life balance and invest in our employees' growth through professional development and continuing education opportunities. Our benefit package includes medical, dental, vision, life insurance, short- and long-term disability, and a generous 401(k) match. At iMPROve Health, we are committed to improving the quality, safety, and efficiency of healthcare. While we do not provide direct patient care, our healthcare professionals-including physicians, nurses, and experienced consultants-partner with providers to promote the use of evidence-based best practices. We offer our clients a trusted, impartial resource that understands the complexities of the healthcare landscape and is dedicated to thoughtful, high-quality solutions. Join us in making a meaningful impact on healthcare-one improvement at a time. About the Role: We are seeking a highly organized and detail-oriented Administrative Assistant to support our Independent Dispute Resolution (IDR) operations under the No Surprises Act. This role plays a critical part in ensuring disputes are prepared accurately, submitted timely, and managed in compliance with federal regulatory requirements. The ideal candidate thrives in a fast-paced, deadline-driven environment, is comfortable navigating multiple technology platforms, can effectively manage a high-volume workload, and demonstrates exceptional administrative, organizational, and documentation management skills. Key Responsibilities IDRE Administrative Support - Manage administrative responsibilities for the Federal IDRE program, including data entry, report generation, and case documentation management. - Download and upload dispute documentation between federal portals, third-party platforms, and internal systems. - Assist with dispute preparation for arbitration, ensuring all submissions are complete, accurate, and compliant with program requirements. - Process disputes for eligibility as required. - Develop and maintain tracking spreadsheets, templates, reports, and other program support tools. - Electronically manage, organize, and maintain dispute-related documentation and records. - Support the preparation and execution of digital signatures and PDF document management activities. Case Tracking & Coordination - Work closely with the Federal IDRE team to track deadlines, case statuses, and required submissions throughout the dispute lifecycle. - Update databases, spreadsheets, and tracking systems with case information and documentation details. - Organize and maintain electronic case files, document repositories, and folder structures. - Coordinate with internal departments, including Finance, Operations, and other support teams, to ensure timely dispute processing and resolution. - Assist with scheduling internal and external meetings and coordinating meeting logistics. - Monitor case progress and proactively identify potential delays, missing documentation, or processing issues requiring escalation. Communication, Inbox Management & Customer Support - Manage a high-volume shared email inbox that receives a broad range of inquiries and requests related to the No Surprises Act and Independent Dispute Resolution process. - Review, prioritize, triage, and route incoming communications to the appropriate team members for action. - Monitor and respond to internal and external email and phone inquiries in a timely and professional manner. - Identify claims or disputes requiring additional investigation, research, or escalation. - Process and coordinate requests related to portal access, account management, and user support. - Coordinate and schedule internal and external meetings and follow-up activities. - Respond to inquiries regarding dispute status, payment status, eligibility determinations, documentation requirements, and general program processes. - Manage and appropriately route complaints, concerns, and questions related to determination decisions and dispute outcomes. - Ensure all communications, inquiries, and requests are documented and tracked according to established procedures. - Support the team in meeting daily processing targets and service expectations while maintaining a high level of customer service. Productivity, Quality & Performance Expectations - Maintain established productivity, quality, and turnaround time standards for the Federal IDRE program. - Effectively manage competing priorities while balancing multiple cases, deadlines, systems, and administrative responsibilities. - Maintain a high level of accuracy and attention to detail while working with large volumes of documentation and data. - Consistently meet case processing, documentation, and quality assurance requirements. - Demonstrate sound judgment when determining appropriate actions, escalation needs, and issue resolution pathways. - Proactively communicate risks, barriers, or delays that could impact case processing or regulatory compliance. - Support continuous process improvement efforts by identifying workflow efficiencies and opportunities to improve team performance and customer service. Compliance & Confidentiality - Ensure adherence to all company policies, procedures, and operational standards. - Maintain compliance with HIPAA, FISMA, URAC, CMS, FAR, and other applicable federal and contractual regulations. - Handle confidential, sensitive, and protected information with the highest level of professionalism and discretion. - Ensure all dispute documentation and communications are managed in accordance with applicable security and privacy requirements. Qualifications Education & Experience - Associate's degree or equivalent combination of education and experience required. - Minimum two (2) years of administrative support experience required. - Experience reviewing medical claims, remittance advice, or Explanation of Benefits (EOBs) strongly preferred. - Familiarity with healthcare billing, reimbursement, payer-provider processes, or healthcare operations preferred. - Experience supporting high-volume administrative workflows and managing shared inboxes preferred. Technical Skills - Experience working with complex technology systems (e.g., Salesforce, SharePoint, third-party portals, case management systems). - Proficiency in Microsoft Excel, Word, Outlook, Teams, and OneNote. - Experience with document management systems, preferably SharePoint. - Comfortable electronically signing, organizing, and managing PDF documents using Foxit or similar tools. - Visio experience is a plus. - Ability to navigate multiple cloud-based systems, databases, and web portals simultaneously. Core Competencies - Exceptional attention to detail and commitment to accuracy. - Strong organizational and time management skills. - Ability to manage multiple deadlines and competing priorities in a fast-paced, deadline-driven environment. - Strong critical thinking and problem-solving skills. - Ability to work independently with minimal supervision. - Excellent written and verbal communication skills. - Customer-service mindset with the ability to professionally manage sensitive, complex, or challenging inquiries. - Ability to maintain productivity and quality standards while handling large volumes of work. - Strong judgment regarding issue identification, escalation, and resolution. Remote Work Requirements - Reliable high-speed internet connection. - Professional, distraction-free home workspace. - Comfortable using virtual communication tools, including Teams, email, chat, and web-based meeting platforms. - Ability to securely manage electronic documents, digital signatures, and confidential information. - Proficiency navigating multiple cloud-based systems, databases, and third-party platforms simultaneously. EOE/VET/Disability - Must be able to work M-F normal business hours in EST. Monday through Friday 8 am to 5 pm EST

Title: PEER REVIEWER - Geriatrician - REMOTE Location: United States Job Description: iMPROve Health is seeking a geriatrician to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. BENEFITS: - Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. - Professional Recognition: Join a network of highly respected experts in your specialty. - Competitive Compensation: Receive fair pay for your time and expertise. - Protect Standards of Care: Help uphold the integrity of your profession. - Work Remotely: Review cases from the convenience of your home or office. DUTIES AND RESPONSIBILITIES: - Conduct objective, evidence-based peer reviews of clinical cases. - Make final determinations regarding medical necessity and quality of care. - Ensure decisions are fair, unbiased, and aligned with current standards of practice. - Submit reviews in a timely and professional manner using the IT systems provided. QUALIFICATIONS: - Medical License: Must hold an unrestricted medical license in any U.S. state. - Board Certification: Required (if applicable), through a board recognized by: - The American Board of Medical Specialties (ABMS), - The American Osteopathic Association (AOA), or - Another nationally recognized board granting certification. - Clinical Experience: - Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. - Have experience providing direct clinical care to patients within the past three (3) years. - Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. - Have the clinical expertise to manage the medical or behavioral health condition or disease under review. - Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. TECHNOLOGY REQUIREMENTS: - Reliable Wi-Fi access. - Proficiency with Microsoft Word. - Access to a computer compatible with iMPROve Health’s IT systems. OTHER REQUIREMENTS: - Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. - Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. - Active hospital medical staff privileges may be required, as applicable. - Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. - Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. EOE/VET/Disability

Title: PEER REVIEWER - BARIATRIC SURGEON - REMOTE Location: United States Job Description: iMPROve Health is seeking a bariatric surgeon to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. BENEFITS: - Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. - Professional Recognition: Join a network of highly respected experts in your specialty. - Competitive Compensation: Receive fair pay for your time and expertise. - Protect Standards of Care: Help uphold the integrity of your profession. - Work Remotely: Review cases from the convenience of your home or office. DUTIES AND RESPONSIBILITIES: - Conduct objective, evidence-based peer reviews of clinical cases. - Make final determinations regarding medical necessity and quality of care. - Ensure decisions are fair, unbiased, and aligned with current standards of practice. - Submit reviews in a timely and professional manner using the IT systems provided. QUALIFICATIONS: - Medical License: Must hold an unrestricted medical license in any U.S. state. - Board Certification: Required (if applicable), through a board recognized by: - The American Board of Medical Specialties (ABMS), - The American Osteopathic Association (AOA), or - Another nationally recognized board granting certification. - Clinical Experience: - Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. - Have experience providing direct clinical care to patients within the past three (3) years. - Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. - Have the clinical expertise to manage the medical or behavioral health condition or disease under review. - Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. TECHNOLOGY REQUIREMENTS: - Reliable Wi-Fi access. - Proficiency with Microsoft Word. - Access to a computer compatible with iMPROve Health's IT systems. OTHER REQUIREMENTS: - Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. - Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. - Active hospital medical staff privileges may be required, as applicable. - Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. - Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. EOE/VET/Disability