Provider Dispute Resolution Specialist

hace 4 semanas

Caimito Barrio, Puerto Rico Vetjobs A tiempo completo
Job Description

Vetjobs is seeking a highly skilled Provider Dispute Resolution Analyst to join our team in a Hybrid Remote setting. As a key member of our team, you will be responsible for reviewing, researching, and resolving complex provider disputes in accordance with state and federal guidelines.

Key Responsibilities:
  • Conduct thorough investigations and reviews of provider disputes to ensure accurate and timely resolutions.
  • Maintain and track assigned caseloads to ensure timely completion and adherence to regulatory guidelines.
  • Provide detailed analyses of findings and recommendations for dispute resolution.
  • Research and analyze provider issues to determine root causes of disputes.
  • Interpret and compile supporting documentation for dispute resolution.
  • Process and adjudicate claims accordingly, adhering to department processes and regulatory guidelines.
  • Communicate with providers in a professional manner, free of grammatical errors, within required regulatory timelines.
  • Participate in ongoing training and professional development to maintain knowledge of claims procedures and regulatory requirements.
Requirements:
  • High School Diploma or equivalent required.
  • Minimum 2-3 years of experience in a managed care claims processing environment, including processing of all medical claim types and handling of complicated claims issues.
  • Minimum 1-2 years of progressive experience as a PDR Coordinator preferred.
  • Knowledge of claims processing systems, medical terminology, and standard coding.
  • Proven problem-solving skills and ability to translate knowledge to the department.
  • Excellent verbal and written communication skills.
  • Ability to multi-task, strong organizational skills, and attention to detail.
  • Familiarity with state and federal regulatory requirements.
  • Ability to read and interpret provider contracts and apply written guidelines and instructions.
Working Conditions:
  • Constant and close visual work at desk or computer.
  • Constant sitting and working at desk.
  • Constant data entry using keyboard and/or mouse.
  • Frequent use of telephone headset.
  • Constant verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
  • Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
  • Frequent walking and standing.

Salary: $33.46 - $50.20/hr

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