Healthcare Provider Disputes Specialist

Healthcare Provider Disputes Specialist

Elite Technical is seeking a Healthcare Provider Dispute Specialist. The selected candidate will coordinate the review of all cases by recording and assigning all provider disputes. Prioritizes, organizes, distributes, and tracks incoming mail/case material. Records the flow of information and assigns it to the appropriate person/queues.

- Reviews processed claims to identify valid provider disputes.
- Creates and assigns dispute cases in EPIC to Provider Dispute Specialists for review and resolution.
- Forwards Medical Appeals, FEP appeals, and Correspondence to the appropriate departments in a timely manner.
- Assigns tasks to Provider Disputes Specialist based on review and research of the incoming provider disputes.
- Assists with creating and maintaining electronic files and hard copy paper files; maintains and tracks department cases and files; assists with preparing and issuing reports required for various internal committee meetings and as needed on an ad hoc basis. Assists with updating database for all dispute cases.
- Coordinates intake, tracking, and distribution of provider disputes, appeals, and correspondence.
- Assists leadership with administrative support, case reporting, and file maintenance while ensuring compliance with privacy and regulatory requirements.

This position is 100% onsite at our clients Baton Rouge Corporate office.

Required Skills

- Education: High School Diploma or equivalent is required.
- 2 years of general medical/insurance office experience with either claims processing knowledge or provider/member servicing is required.
- Must have strong experience reviewing and researching incoming provider disputes.
- Must have experience using Microsoft Office applications, including Word, Excel and PowerPoint.
- Facets experience is preferred.

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