Provider Dispute Representative

About This Role

Requisition #20437

Employment Type

Temporary

Location

Full Time - On-site

Education

Degree

Experience

Pay Scale : $32.96 – $36.42

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

Position Summary

Responsible for providing clerical support for the provider dispute process, processing routine disputes, preparing reports, and assisting with various other departmental clerical tasks. Provides excellent service to providers by telephone, researching and answering questions about claim disputes and educating providers regarding health plan procedures.

Position Details

Essential Duties and Responsibilities

  • Responds to routine provider inquiries via telephone assisting with provider dispute status, procedures and general inquiries
  • Contacts providers to obtain missing information or provide education regarding health plan procedures
  • Processes provider disputes/complaints according to established policies and procedures, including:
  • Prepares provider dispute files and gathers supporting data/documentation
  • Logs cases by entering information into the provider dispute database
  • Prepares and sends provider dispute acknowledgement notices
  • Prepares and sends dispute resolutions notices to providers
  • Updates dispute log and files completed cases
  • Generates provider dispute reports using Access database
  • Archives provider dispute files in a retrievable manner
  • Researches and resolves routine provider disputes according to procedure
  • Monitors timeliness of disputes and informs manager of cases approaching deadlines
  • Sends forms to providers upon request (PDR Form, Service Authorization Forms, Consultation Referral Forms, etc.)
  • Prepares reports using Access and Excel
  • Assists with Provider Dispute audits by gathering and organizing requested materials.
  • Orders department office supplies
  • Processes mailings and faxes to contracted providers
  • Other duties as assigned

Qualifications

  • • Bachelor’s degree preferred or equivalent experience.
    • Three years of experience working in managed healthcare/insurance environment, preferably in claims or provider disputes.
    • Knowledge of medical terminology and claims experience preferred.
    • Proficient Microsoft Office
    • Proficient in Excel

Physical Requirements

  • Able to lift up to 30 pounds
  • Use proper body mechanics when handling equipment
  • Standing, walking and moving 50% of the day.

Compliance Requirements

Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.

Join Our Team

If you are passionate about improving the health of our local community & want to fill this position, please apply now.

Apply Now

We are continuously looking for exceptional additions to our team. If you need help, or a job you\’re looking for isn\’t listed on this website, please email us at [email protected].

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