Provider Disputer Resolution
1 week ago
Summary:
As a Provider Dispute Resolution Examiner, you will be responsible for handling the provider dispute resolution process, resolving disputes in a timely and fair manner, and maintaining accurate records of disputes and their resolution. You will collaborate with providers, internal teams, and external stakeholders to ensure that disputes are resolved in accordance with industry standards and regulatory requirements.
Duties and Responsibilities:
· Meets production standards of 20-30 Hospital Provider Dispute claims per day and 50-75 IPA Provider Dispute claims as established by claims management.
· Assists in other IPA's when needed.
· Submits automation requests through SharePoint.
· Processes Customer Services Inquiries.
· Assists with training new hires.
· Continue with ongoing training to further Claims Adjudication knowledge
· Performs other tasks as assigned by supervisor/manager.
· Attends training meetings and asks questions.
· Provides auditor with training suggestions/examples.
· Adhere to Claims Department policies and procedures. Keeps updated materials and resources provided for accurate and expedient adjudication.
· Ensure that the Examiner's Checklist is verified and done.
· Provide auditor examples of examiner errors.
Minimum Job Requirements:
· Must have a high school diploma or equivalent.
· Must have knowledge of medical terminology, ICD-9, CPT-4, treatment of diagnoses, and COB.
· Minimum 2 years as Examiner II
Skills and Abilities:
· Must be able to communicate with others clearly, tactfully, and professionally.
· Must have strong computer skills with a broad knowledge of software packages. Must be able to follow directions and perform independently according to departmental standards when no directions are given.
· Must possess effective communication skills. Must be able to willingly accept responsibility and possess the desire to learn new tasks.
· Must have strong organizational and mathematical skills.
-
Provider Dispute Resolution Intake Coordinator II
Found in: beBee S US - 7 days ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $45,760.00 (Min.) - $47,823.00 (Mid.) - $55,818.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Provider Dispute Resolution Intake Coordinator II
Found in: beBee jobs US - 1 week ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $45, Min.) - $47, Mid.) - $55, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Manager, Claims Integrity Provider Remediation
Found in: beBee jobs US - 2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $102, Min.) - $132, Mid.) - $156, Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Manager, Claims Integrity Provider Remediation
Found in: beBee jobs US - 2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $102, Min.) - $132, Mid.) - $156, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Managing Director
1 week ago
Los Angeles, United States LVI Associates Full timeLVI are currently seeking a senior-level construction manager or engineer to provide direction and exceptional leadership for all aspects of technical and managerial services. In this role, the successful candidate will have an opportunity to expand and grow the client's various practices while leading high-profile projects - including, but not limited to;...
-
Managing Director
Found in: Appcast Linkedin GBL C2 - 2 weeks ago
Los Angeles, United States LVI Associates Full timeLVI are currently seeking a senior-level construction manager or engineer to provide direction and exceptional leadership for all aspects of technical and managerial services. In this role, the successful candidate will have an opportunity to expand and grow the client's various practices while leading high-profile projects - including, but not limited to;...
-
Manager, Claims Integrity Provider Remediation
Found in: beBee S US - 1 week ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $156,000.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members...
-
Manager, Claims Integrity Provider Remediation
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $156,000.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2...
-
Managing Director
Found in: Jooble US O C2 - 2 weeks ago
Los Angeles, CA, United States LVI Associates Full timeLVI are currently seeking a senior-level construction manager or engineer to provide direction and exceptional leadership for all aspects of technical and managerial services. In this role, the successful candidate will have an opportunity to expand and grow the client's various practices while leading high-profile projects - including, but not limited...
-
Provider Network Assistant
Found in: Talent US C2 - 2 weeks ago
Los Angeles, United States Los Angeles Jewish Home Full timeWe value our employees! We offer long term employment opportunities with job stability, including supporting and encouraging career growth advancement. We offer Health, Dental and Vision insurance, Paid Time Off, 9 Paid Holidays, 403(b) with Matching Retirement Plan, Life insurance (paid by the company) and a team spirit workplace culture! Provider...
-
Los Angeles, United States 4MEDICA, INC Full timeWho We Are: 4medica® is a leading innovator of real-time clinical data management and healthcare interoperability software and services, providing clinicians with a unified view of patient/person information nationwide. The company participates in multiple healthcare markets (verticals) by leveraging its best-in-class data management and interoperability...
-
Senior Attorney
1 week ago
Los Angeles, United States Direct Counsel, LLC Full timeJob DescriptionJob DescriptionDirect Counsel is seeking a Senior Attorney to join a highly ranked firm in their Global Franchise & Supply Network Practice Group. This firm is a dynamic and rapidly growing law firm with a strong commitment to delivering exceptional legal services. As a Senior Attorney in their Global Franchise & Supply Network Practice Group,...
-
Senior Attorney
7 hours ago
Los Angeles, United States Direct Counsel Full timeDirect Counsel is seeking a Senior Attorney to join a highly ranked firm in their Global Franchise & Supply Network Practice Group. This firm is a dynamic and rapidly growing law firm with a strong commitment to delivering exceptional legal services. As a Senior Attorney in their Global Franchise & Supply Network Practice Group, you will play a crucial role...
-
Senior Project Manager I
7 days ago
Los Angeles, United States Dr. Cat Plastic Surgery Full timeSenior Project Manager I Duties: Resolves complex construction project related issues, disputes, and disagreements Develops, assigns, and monitors performance of OARs relative to assigned construction projects Reviews status and overall construction project progress relative to submitted construction schedules Reviews change orders from all construction...
-
Utilization Management/Appeals and Grievances Nurse Specialist RN II
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members...
-
Senior Project Manager I
1 week ago
Los Angeles, United States Element Consulting Full timeJob DescriptionJob DescriptionSenior Project Manager IDuties:Resolves complex construction project related issues, disputes, and disagreementsDevelops, assigns, and monitors performance of OARs relative to assigned construction projectsReviews status and overall construction project progress relative to submitted construction schedulesReviews change orders...
-
Senior Attorney
Found in: Resume Library US A2 - 1 week ago
Los Angeles, California, United States Direct Counsel, LLC Full timeDirect Counsel is seeking a Senior Attorney to join a highly ranked firm in their Global Franchise & Supply Network Practice Group. This firm is a dynamic and rapidly growing law firm with a strong commitment to delivering exceptional legal services. As a Senior Attorney in their Global Franchise & Supply Network Practice Group, you will play a crucial...
-
Utilization Management/Appeals and Grievances Nurse Specialist RN II
Found in: beBee jobs US - 1 week ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $88, Min.) - $115, Mid.) - $142, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Utilization Management/Appeals and Grievances Nurse Specialist RN II
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Junior Defense Attorney
Found in: Jooble US O C2 - 2 weeks ago
Los Angeles, CA, United States JBA International Full timeA fast-growing law firm in Los Angeles is seeking junior attorneys to join them. The firm specializes in the defense and counseling of businesses, insurers, professionals, and public entities. Our extensive experience in civil litigation, trials, and alternative dispute resolution, as well as our state-of-the-art research technology, enable us to provide...
