Position Summary
Summit Innovative Solutions is growing its state-level arbitration team and is seeking a Team Lead to own this function end-to-end. You will build the framework, lead a team, and drive the strategy that positions Summit as the premier RCM partner for state arbitration. The Team Lead of State IDR will supervise and coordinate daily operations, carry responsibility for mentoring a team, and support the continued growth of Summit. This role works closely with our Federal IDR team to ensure accurate submissions across both state and federal arbitration tracks.
Key Responsibilities
- Own the daily operations of the state IDR function.
- Partner closely with the Federal IDR team to maintain alignment across federal and state arbitration tracks.
- Serve as Summit's internal authority on state-specific arbitration rules.
- Mentor and develop team members through training, coaching, and performance management.
- Analyze workflow and case data to identify state IDR-eligible claims.
- Verify patients' insurance plan types to determine state jurisdiction applicability
- Maintain expertise on state-specific rules.
- Develop and document a scalable onboarding framework for each new state Summit enters.
- Track state-level arbitration trends by arbitrator, health plan, and outcome to guide strategic decision making.
- Serve as a primary liaison with external stakeholders including state DOI personnel, arbitrators, and dispute resolution entities.
- Manage the flow of day-to-day operations and assist with identification of trends by arbitrator and health plan.
- Complete special projects as directed.
- Prepare concise executive-level summaries highlighting trends, risks, and opportunities.
- Present insights and recommendations in decision‑ready formats.
- Support forecasting, reimbursement optimization, and payer strategy planning.
Skills and Specialized Knowledge
- Deep knowledge of the IDR process, particularly the distinction between federal and state processes.
- Understanding of insurance plan structures and their implications for state IDR.
- Strong problem-solving skills with the ability to interpret regulatory language and translate it into operational guidance.
- Knowledge of medical terminology (I.E. CPT codes, and ICD-10).
- Ability to clearly communicate with internal leadership and external parties.
- Demonstrated ability to motivate, coach, and develop team members in a fast-paced, deadline-driven environment.
- Proficiency in MS Office applications including Word, Excel, Outlook, Access, and PowerBI.
- Proven ability to maintain high productivity standards and manage multiple concurrent caseloads and projects.
Preferred Experience
- Bachelor's degree in Data & Analytics, Healthcare Administration, or related field
- 2+ years of Revenue Cycle Management experience
- IDR experience preferred (state or federal)
- People leadership experience preferred
- Experience with state DOI or regulatory bodies a plus
- Multi-state arbitration exposure a plus
Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
Work Location: Remote
