Dispute Resolution Specialist
3 weeks ago
MedPOINT Management is seeking a highly skilled Dispute Resolution Specialist to join our team.
Job SummaryThe 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.
- 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.
This position requires strong communication and organizational skills, attention to detail, and ability to work independently with minimal supervision.
BenefitsAs 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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