Provider Inquiry Coordinator

Claims Dispute Resolution Specialist

Research and resolve claims disputes coming from participating providers. Responsibilities include:

• Research and resolve claim disputes by navigating company's claims system and multiple platforms
• Ensure timely, efficient, accurate and compliant resolution of claim disputes
• Research provider contract, fee-schedules, claim rules, correct application of benefits, prior authorizations and member eligibility as they relate to claim disputes
• Identify opportunities to improve claims processing, and reduce risk and inefficiency
• Review claim dispute reports for data integrity and perform necessary updates
• Perform data entry of claims disputes
• Handle provider telephone calls and e-mails regarding the status of claim disputes
• Work with the Provider Relations team and support claim dispute escalations
• Communicate with internal departments as required
• Meet performance metrics and goals established for the position
• Performs additional duties and responsibilities as assigned by management

Qualifications:

• Minimum experience of 3 years in healthcare operations; experience with Medicare Advantage regulatory requirements
• Knowledge of Professional and Facility claims and claim disputes, provider compensation, benefits, coding and medical terminology
• Solid organizational and administrative skills
• Able to thrive in a high-pressure environment
• Written and oral communication skills
• Computer literacy and advanced Excel spreadsheets for operational data analysis and reporting

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member. Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.