Dispute Resolution Specialist

4 days ago


Topeka, Kansas, United States Blue Cross and Blue Shield of Kansas Full time
Job Summary

The Dispute Resolution Specialist will be responsible for negotiating with non-contracting providers on behalf of the Professional Relations Department. This role will involve creating and submitting offers to the IDR entity in the event of failed negotiations.

Key Responsibilities
  • Develop and maintain general procedure documents for negotiations with non-contracting providers.
  • Attend ongoing meetings with internal teams to discuss negotiation strategies and updates.
  • Establish and maintain direct contact with providers, attorneys, accountants, billing agents, IDR entities, and state insurance departments to negotiate claims and resolve disputes.
  • Research claim adjustments, verify correct provider payment per LOA/IDR determination, and maintain an ongoing understanding of reimbursement levels and issues.
  • Manage IDR arbitration and ensure timely resolution of disputes.
Requirements
  • Bachelor's Degree in Business, Economics, Education, or a similar field.
  • Minimum of 3 years of work experience with Blue Cross and Blue Shield of Kansas.
  • Knowledge of the Consolidated Appropriations Act and No Surprise Bill Legislation.
Benefits
  • Competitive salary range: $60,800 - $72,000.
  • Exempt grade 14.
  • Excellent benefits package, including health, vision, and dental insurance, 6 weeks of paid parental leave, fertility/adoption assistance, 2 weeks of paid caregiver leave, 5% 401(k) plan matching, tuition reimbursement, and health and fitness benefits.


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