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IDR Analyst

recoursehealth.com

  • San Francisco, California
  • 1 day ago

    Highlights

    Comfortable reading EOBs, 835 remittance files, CPT codes, and claim adjustment reason codes. If you want this to be the most memorable stretch of your career, where you shipped something real, with a team you respected, in a domain that actually matters, this is the seat.

    Numbers & Facts

    LocationSan Francisco, California
    Websiterecoursehealth.com

    Description

    Run the federal arbitration cases that recover real money for real providers. Make the system smarter with every one.


    Why This Exists

    A federal arbitration system called Independent Dispute Resolution, or IDR, now determines billions of dollars in healthcare payments each year. Providers win the vast majority of disputes, yet most eligible claims are never filed. The process is manual, fragmented, and resource-intensive, and most providers don't have the infrastructure to pursue what they're owed.

    The No Surprises Act created the framework, and the market already exists. Today it runs on spreadsheets, consultants, and static playbooks. We're building the first intelligent system designed to operate inside it.

    This role sits inside that system. You will run real disputes end to end: eligibility, deadlines, submissions, correspondence, resolution. Every claim you touch teaches us something about how to make the next one better.


    Why This Is Hard (and Interesting)

    You will not inherit a mature process. You will help build it.

    Claims data is messy. Payers adapt. Deadlines cascade. Audit trails matter. One missed detail can cost a provider real money, or cost us a CMS fee on a dispute we never should have filed. You'll develop sharp instincts for where money gets left on the table and where the system needs a better guardrail.

    What's different here is the second half of the job. You won't just run the process, you'll improve it. When you spot a pattern in the claims, you write it down, we build it, and the next hundred disputes run better because of you.

    That means the job grows as you do. In month one you're running cases. By month six you're deciding how they should be run, steering the tooling that handles the routine parts, and spending your time on the disputes that actually need judgment.

    If you've been watching AI reshape this kind of work and want to be the person directing it rather than the person it happens to, this is a rare seat.


    Who We Are

    Recourse is being built in partnership with 25M Health, a healthtech venture firm. We have institutional backing, a shared platform team spanning engineering, strategy, design, and back-office, and early access to large provider systems.

    We are actively filing disputes for real customers, including a large multi-facility health system and a litigation-finance partner with hundreds of millions in claim value. This is a funded, validated opportunity with real customers and real data.

    We are a small, nimble team. We move quickly and we value clarity over theater. We want this to be the best work of your career. The stretch you look back on as the one where you shipped real things, with people who raised your game, on something that mattered.

    We care about clear thinking, high ownership, intellectual honesty, and direct communication. We believe operations, product, and engineering should operate as one pod, not three functions. We want the machines to do machine work, and the humans to do their best work.


    The Role

    You'll report to our Head of Operations and own the day-to-day running of IDR disputes. You will:

    • Evaluate dispute eligibility against federal IDR requirements before anything gets filed
    • Own submissions through the CMS portal: documentation, offer amounts, supporting briefs
    • Monitor deadlines across active disputes and make sure nothing lapses on procedure
    • Handle correspondence with payers and IDR entities, and track every follow-up to close
    • Verify cases actually resolved, catching premature or missed closures before they cost us money
    • Read 835 remittance files and EOBs to reconstruct what a payer actually did and why
    • Turn every recurring pattern you spot into a spec, a checklist, or a prompt that makes the next case easier
    • Work directly with AI tools to take the repetitive parts off your plate, then partner with engineering to make those improvements permanent

    This is not a ticket-queue role. You will write code-adjacent artifacts, specs, SQL queries, workflow notes, AI prompts, and you will ship them. You'll learn the domain deeply, and you'll shape how the company actually works.


    Who You Are

    You have real claims instincts. You can read an EOB and tell what happened. You know what a denial code means without looking it up. You've chased a payer for money that was owed and you know how that conversation goes.

    You are AI-pilled. You've used AI tools to do work that would have taken a team. You have opinions about which ones are useful and which are hype. You stay current because the world is changing and you want to see the next shift before anyone else.

    You care about the details. You notice when a number is slightly off. You follow the thread until you understand it. In this work, one missed detail is real money.

    You have a bias to action. You don't default to no. Speed of iteration over polish of iteration. You start, you learn, you fix things in motion. Most decisions are reversible and do not need extensive study.

    You are intellectually honest and curious. You ask questions when you don't understand something. You say so when you're wrong. You use plain language. You respectfully challenge decisions you disagree with, and once a decision is made, you commit.

    You put the team first. You are reliable and fully invested. You take your vacations. You check on your teammates. You help build a culture where people do their best work because they are supported, not squeezed.


    What You Bring

    • 2 to 4 years in revenue cycle, claims operations, denials, appeals, or medical billing
    • Comfortable reading EOBs, 835 remittance files, CPT codes, and claim adjustment reason codes
    • Hands-on fluency with AI tooling (Claude, ChatGPT, or similar). You have used it to ship or accelerate real work, not just tried the demos
    • Comfort with data and analytical tools (Excel or Sheets at pivot-table level, SQL a plus). You can pull answers yourself rather than filing a request
    • Clear written communication. You can turn a messy situation into a crisp summary
    • The ability to manage a lot of competing deadlines without dropping any of them
    • A preference for small teams and early-stage chaos over mature org charts

    Strong plus, not required: direct experience with Independent Dispute Resolution, the No Surprises Act, arbitration, or out-of-network claims. If you have it, you'll move faster. If you don't, we'll teach you.

    Sound judgment, operational depth, and ownership mindset are required. Grit matters more than pedigree.


    Why This Role

    Most claims jobs are the same job at a different company. Same queue, same volume, same work next year as this year. This one isn't.

    Here the work compounds. You will learn how federal arbitration actually works, and you'll learn how to turn operational knowledge into systems that scale. Both of those are rare, and the combination is rarer. Six months in you will be doing a harder and more interesting job than the one you started, because you built the thing that handles the easy part.

    You'll also be joining early at a company with real customers and real revenue. Small team, so your work shows up in the numbers immediately.

    If you want this to be the most memorable stretch of your career, where you shipped something real, with a team you respected, in a domain that actually matters, this is the seat. Please apply even if you don't fit 100% of these requirements. We would like to talk.


    Equal Opportunity

    Recourse is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We believe the best teams are built from people with different backgrounds and perspectives, and we're committed to creating an environment where everyone can do their best work.

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