Healthcare Appeals & Compliance Specialist

Salary: $60k-$70k annually, DOE

Job Summary:

Green Light is a rapidly growing healthcare technology company seeking motivated professionals with experience in healthcare claims, appeals, reimbursement, and provider services, supporting Independent Dispute Resolution (IDR) under the No Surprises Act. The Healthcare Appeals & Compliance Specialist supports the fair, consistent, and compliant resolution of payment disputes between healthcare providers and health plans in accordance with federal law.

The ideal candidate is organized, analytical, and comfortable working within structured regulatory frameworks. Individuals with experience supporting legal, arbitration, or regulatory functions, particularly in healthcare, will find this role especially well aligned. We value team players with strong professional judgment, integrity, and a collaborative mindset who are excited to help drive meaningful change in healthcare.

Responsibilities:

• Support and administer disputes subject to the No Surprises Act (NSA), with a primary focus on the Independent Dispute Resolution (IDR) process, including Open Negotiations and formal IDR submissions.
• Review, organize, and analyze dispute materials to ensure completeness, accuracy, and compliance with statutory, regulatory, and procedural requirements.
• Apply applicable federal regulations, health plan policies, and pricing methodologies when evaluating disputes and supporting determination outcomes.
• Conduct structured research of claims, appeals, and supporting documentation to identify relevant facts, regulatory considerations, and potential resolution pathways.
• Draft, compile, and maintain formal dispute documentation, including written summaries, settlement agreements, procedural correspondence, and supporting records suitable for regulatory review or audit.
• Facilitate timely and accurate exchange of information among healthcare providers, health plans, internal teams, clients, and other stakeholders throughout the IDR lifecycle.
• Communicate clearly and professionally with provider billing representatives and other parties to explain IDR processes, timelines, procedural requirements, and outcomes.
• Track and manage multiple concurrent disputes, ensuring adherence to federally mandated timelines and internal quality standards.
• Collaborate cross-functionally to promote consistency, transparency, and compliance in dispute resolution practices.
• Maintain complete and well-organized records to support internal quality reviews, audits, and external regulatory inquiries.
• Ensure ongoing compliance with HIPAA, confidentiality obligations, and information security requirements.

Qualifications:

• 35 years of experience in healthcare claims, appeals, dispute resolution, regulatory compliance, or legal support.
• Demonstrated experience working with the No Surprises Act, including Open Negotiation and/or IDR processes, preferred.
• Paralegal experience or prior work supporting legal, arbitration, or regulatory functions is strongly preferred.
• Strong analytical, research, and organizational skills, with the ability to interpret and apply regulatory guidance.
• Excellent written and verbal communication skills, including experience preparing formal correspondence or documentation for regulated processes.
• Working knowledge of healthcare billing, reimbursement methodologies, and medical terminology.
• Ability to manage multiple matters simultaneously while meeting strict regulatory deadlines.
• High school diploma or equivalent required; additional education or certification in paralegal studies, legal studies, healthcare administration, or a related field is a plus.
• Familiarity with healthcare coding, claims systems, or dispute management platforms is a plus.
• Knowledge of HIPAA and appreciation of the importance of data privacy and information security.