Dispute Resolution Specialist

3 weeks ago


Los Angeles, California, United States MedPOINT Management Full time

MedPOINT Management is seeking a highly skilled Dispute Resolution Specialist to join our team.

Job Summary

The successful candidate 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.

Key Responsibilities:
  • Meet production standards of 25-35 Hospital Provider Dispute claims per day and 50-75 IPA Provider Dispute claims as established by claims management.
  • Collaborate with providers, internal teams, and external stakeholders to ensure that disputes are resolved in accordance with industry standards and regulatory requirements.
  • Submit automation requests through SharePoint.
  • Process Customer Services Inquiries.
  • Assist with training new hires.
  • Perform other tasks as assigned by supervisor/manager.
  • Attend training meetings and ask questions.
  • Provide auditor with training suggestions/examples.
  • Adhere to Claims Department policies and procedures. Keep updated materials and resources provided for accurate and expedient adjudication.
  • Ensure that the Examiner's Checklist is verified and done.
  • Provide examples of common PDRs/trends to Supervisor.
  • Provide auditor examples of examiner errors.
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 III.
Working Conditions

This position requires strong communication and organizational skills, attention to detail, and ability to work independently with minimal supervision.

Benefits

As a valued member of our team, you will enjoy competitive compensation and benefits package, including a salary of $65,000 - $85,000 per year, depending on experience, plus benefits and opportunities for growth and professional development.



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