Job Description:
• Review provider dispute resolutions according to organizational guidelines.
• Research and respond to provider participation and pricing inquiries, specifically related to network contracts and agreements.
• Research identified issues; submit claim adjustment requests and determine the root cause of disputes.
• Serve as subject matter expertise in evaluating and responding to provider participation and pricing inquiries.
• Analyze post-paid healthcare claims as it relates to pricing needs.
• Apply in-depth research to determine accuracy of PPO(s) use and pricing discounts applied.
• Communicate externally and with internal departments as it relates to various cases under review.
• Coordinate with other departments as necessary to facilitate resolution of claim related participation and pricing issues.
• Reading and interpreting appeals, standard reference materials, etc.
• Perform other duties as assigned.
Requirements:
• 2+ years of experience in healthcare, specifically with medical terminology, claim forms, and physician billing coding.
• 1+ years of experience with provider disputes.
• Demonstrated technical proficiency with Microsoft Office applications (Outlook, Excel, Teams, etc.).
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
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