IDRE QA Specialist | CMS Compliance Career Growth

IDRE QA Specialist | CMS Compliance Career Growth — Remote Career Path & Skill Development: This role sits at the intersection of healthcare QA, regulatory compliance, and federal program operations — a niche but growing field since the No Surprises Act expanded the IDRE process. Experience here builds expertise in CMS regulatory frameworks, HIPAA/PHI compliance, and healthcare dispute resolution — skills that are increasingly in demand as federal healthcare programs expand. Work-Life Balance Signals: The posting emphasizes a "deadline-driven environment," which is realistic for CMS-bound reporting cycles. However, the remote-first setup, generous PTO, and comprehensive disability/insurance benefits suggest the company invests in employee stability. The 401(k) match and no-cost disability coverage are strong green flags for a small-to-mid-size government services firm. Compensation Context: No salary is listed, which is a yellow flag for transparency. For US healthcare QA specialist roles, market rates typically range from $45,000–$70,000 annually depending on experience and location. The LPN or associate's degree preference suggests this is positioned at a mid-entry level. Green flag: Niche IDRE expertise is highly transferable to other federal health program contractors. Green flag: Apple equipment + media stipend signals a modern, remote-first culture. Yellow flag: No salary disclosed; ask early in the process. Yellow flag: "Room for professional growth" is mentioned but no specific advancement path is outlined. This role suits candidates building a career in healthcare compliance, federal contracting, or clinical QA who want structured work with meaningful regulatory impact. North Haven Government Services Solutions is seeking a skilled and detail-oriented IDRE QA Specialist to join our growing Operations team. This is an important role within our Independent Dispute Resolution (IDR) process, ensuring the accuracy, completeness, and timely delivery of reports to the Centers for Medicare & Medicaid Services (CMS). The QA Specialist serves as a key point of coordination between customers, reviewers, and management, helping ensure that each completed reviewer report meets established requirements and is delivered within required timeframes. What We're Looking For The ideal candidate is highly organized, detail-oriented, and able to manage multiple priorities in a deadline-driven environment. Strong communication skills, sound judgment, problem-solving abilities, and a commitment to accuracy are essential. North Haven Solutions values innovation, collaboration, accountability, and integrity. We offer an engaging work environment where your contributions make a meaningful difference. If you are looking for a challenging and rewarding opportunity with room for professional growth, we invite you to join our team and help us deliver excellence without exception. Key Responsibilities Review reviewer reports for accuracy, completeness, and adherence to customer requirements, company standards, and applicable clinical guidelines. Coordinate and communicate effectively with customers, reviewers, and management to resolve questions, address deficiencies, and facilitate timely report completion. Ensure reports meet established quality standards and are submitted to CMS within required deadlines. Identify discrepancies, missing information, and opportunities for improvement throughout the review process. Maintain a strong understanding of company processes, quality expectations, and applicable IDRE requirements. Contribute to continuous process improvement initiatives designed to enhance quality, efficiency, and turnaround times. Work collaboratively with the Operations team to support the company's continued growth and operational success. Evaluate the quality of the dispute rationale/determination to ensure that all requirements have been met in compliance with internal and CMS guidelines. Follow up with arbiters for any pertinent and missing information. Assess whether the rationale is logical and the conclusions are based on sound assumptions. Maintain professionalism and courtesy when responding to emails and other communications, while ensuring all communications involving HIPAA and PHI are handled appropriately, securely, and in accordance with applicable privacy and confidentiality requirements. Education & Credentials An LPN, Associate's, or Bachelor's degree is preferred; relevant professional experience in lieu of a degree may be considered. Job-Relevant Experience Join our team at Dane Street Government Services (North Haven Solutions) and enjoy a comprehensive benefits package designed to support your well-being and peace of mind: Medical, dental, and vision coverage for you and your family Voluntary life insurance options for you, your spouse, and your children Voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans Basic life insurance, short-term disability, and long-term disability coverage at no cost Generous paid time off policy 401(k) plan with company match Apple equipment and a media stipend provided for remote workspace About Dane Street Government Services Dane Street's Government Services Division provides specialized, compliant solutions that support federal and state program needs with efficiency, accuracy, and integrity. Through services such as Independent Dispute Resolution (IDR), North Haven partners with organizations to deliver clear outcomes that meet both operational and clinical standards. We serve as a trusted resource, bringing clarity, consistency, and confidence to complex review processes. Is this IDRE QA Specialist position fully remote? Yes — the posting confirms that Apple equipment and a media stipend are provided for a remote workspace, indicating this is a remote role. Candidates should be US-based given CMS and HIPAA compliance requirements. What education or credentials are required for this role? An LPN license, Associate's degree, or Bachelor's degree is preferred. However, the company states that relevant professional experience in lieu of a degree may be considered. What kind of healthcare experience is preferred? North Haven prefers candidates with business experience in a healthcare and/or insurance setting, particularly those familiar with quality review processes, clinical documentation, or compliance environments. What is the salary range for this position? The job posting does not disclose a salary range. For similar healthcare QA specialist roles in the US, market rates typically fall between $45,000 and $70,000 annually — candidates should inquire during the interview process. What does day-to-day work look like for this IDRE QA Specialist role? You will review medical dispute reviewer reports for accuracy and compliance with CMS and company guidelines, coordinate with arbiters and customers to resolve deficiencies, and ensure timely submission of completed reports to the Centers for Medicare & Medicaid Services. #J-18808-Ljbffr North Haven Solutions