IRO -Operations Administrator (59121)

Founded in 2012, Capitol Bridge is based in Arlington, Virginia and has proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing and eligibility reviews.

Capitol Bridge is seeking a Operations Administrator to join our growing team.

Job Overview

We are seeking a highly organized and detail-oriented assistant to support Independent Review Organization (IRO) case management activities . This role serves as the administrative backbone of the external medical review process by coordinating case documentation, maintaining tracking systems, managing secure file sharing, preparing correspondence, supporting clinical reviewers, and overseeing invoicing and final case distribution.

The ideal candidate thrives in a fast-paced regulatory environment, demonstrates exceptional attention to detail, and can effectively manage multiple cases while ensuring compliance with state-specific deadlines and requirements.

Location: Remote

Pay and Benefits:

Salary:$22/hour

Medical, Dental, and Vision benefits available

401(k) available with company match

Paid holidays

Paid Vacation Time

Job Responsibilities

Case Intake and Administrative Support

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  Accept and process newly assigned review cases.

  
  

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  Create and maintain case folders within secure document management systems.

  
  

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  Review incoming documentation and identify enrollee, representative, and health plan contact information.

  
  

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  Maintain accurate case records and tracking spreadsheets.

  
  

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  Request missing contact information or documentation from stakeholders as needed.

  
  

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  Monitor case timelines and ensure compliance with state-specific requirements.

  
  

Document Management & File Administration

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  Organize, upload, rename, and maintain case-related documents for efficient review.

  
  

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  Create and manage secure ShareFile accounts for health plans, providers, and clinical reviewers.

  
  

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  Prepare, encrypt, and distribute confidential documents using approved security protocols.

  
  

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  Assist stakeholders with secure document submission through email, file-sharing platforms, or mail.

  
  

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  Maintain complete and organized electronic case files throughout the review process.

  
  

Clinical Reviewer Coordination

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  Prepare medical reviewer forms and supporting documentation for clinical reviewers.

  
  

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  Set up and manage secure reviewer access to case materials.

  
  

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  Distribute reviewer instructions and required forms.

  
  

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  Track reviewer submissions and ensure all required documentation is received.

  
  

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  Maintain communication with reviewers regarding administrative requirements.

  
  

Final Determination Administration

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  Prepare cover letters and final determination mailing packets for all involved parties.

  
  

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  Assemble state-specific correspondence packages and supporting documentation.

  
  

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  Coordinate secure electronic distribution and certified mail delivery.

  
  

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  Maintain tracking records for all mailed and emailed determination packets.

  
  

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  Archive final case documentation according to organizational procedures.

  
  

Invoice Processing & Payment Tracking

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  Generate invoices based on state-specific fee schedules.

  
  

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  Distribute invoices to health plans and applicable regulatory entities.

  
  

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  Monitor invoice due dates and payment status.

  
  

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  Maintain invoice tracking systems and supporting documentation.

  
  

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  Send payment reminders and coordinate with finance personnel regarding outstanding payments.

  
  

Compliance and Reporting

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  Ensure adherence to state IRO regulations, confidentiality requirements, and internal procedures.

  
  

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  Maintain case tracker, monitoring reports, and invoice records.

  
  

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  Document daily case activity, communications, and phone logs.

  
  

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  Preserve accurate records for audit and compliance purposes.

  
  

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  Support project leadership with administrative reporting and operational updates.

  
  

Required Qualifications

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  Minimum of high school diploma or GED equivalent required

  
  

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  2+ years of experience in administrative operations, healthcare administration, insurance, legal support, or case management.

  
  

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  Professional demeanor and excellent customer service skills

  
  

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  Strong proficiency with Microsoft Office Suite, including Excel, Outlook, and Word.

  
  

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  Experience managing confidential and sensitive information.

  
  

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  Excellent organization, prioritization, and time-management skills.

  
  

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  Excellent Communicator with Strong written and verbal communication skills.

  
  

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  Ability to work independently and manage multiple deadlines simultaneously.

  
  

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  Exceptional attention to detail and accuracy.

  
  

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  Thrives working both independently (a self-starter) and collaboratively

  
  

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  Dependable, respectful and consistently works to uphold company ethics and standards

  
  

Reasonable Accommodation

If you require alternative methods of application or screening, you must approach the employer directly to request this. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

EEO Statement

Capitol Bridge LLC. is an Equal Opportunity Employer. All employment decisions at Capitol Bridge are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

Texting Notice

We communicate with applicants by text in additional to email and phone. If you apply for this position, we may text you about this position, your application for the position or other things relevant to this job position. If we text you and you no longer want us to text you, you can opt out at that time.