Provider Dispute Coordinator - Medical Claims

HEALTHCARE - MANAGED CARE

-Candidate must have experience in Managed Care Claims Processing-

Point of contact for submission/resolution of Provider Dispute Resolutions in the Claims Department.  Assesses and completes appropriate documentation for tracking/trending data.  Conducts all pertinent research in order to evaluate, respond and close incoming Provider Disputes accurately, timely and in accordance with all established regulatory guidelines.  Interface with internal departments and external resources and organizations.  Prepares and assist with reports for unit.  Maintain confidentially as required.

Research and document each Provider Dispute in a thorough, professional and expedient manner.  Coordinate workflow between departments and interface with internal and external resources.  Formulate conclusions.

Strong organizational skills and attention to detail.Ability to perform independently, handle multiple projects, problem solving abilities and able to conduct analysis. Knowledge of AB-1455 standards.