Dispute Specialist
New
W
WelbeHealthManaged care
Location: Remote, USAFull-TimeMiddle
Salary33.8 - 39.14 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum of three (3) years of health plan claims processing experience, and two (2) years of health plan claims dispute experience analyzing and resolving provider claims
- Required Skills
- Microsoft ExcelPowerPoint
Requirements
- High school diploma or equivalency; professional experience may be substituted.
- Experience in a Managed Care Plan (MCP) or PACE organization (PO) claims processing environment.
- At least three years of health plan claims processing experience.
- At least two years of health plan claims dispute experience analyzing and resolving provider claims.
- Strong computer and software knowledge, including Excel, Outlook, PowerPoint, Word, and Teams.
- Knowledge of job-specific applications and systems used to produce correspondence, charts, spreadsheets, and other information.
- Ability to navigate state and federal websites and medical billing guidelines to resolve outstanding claims and disputes.
- Verbal and written communication, organizational, time management, problem-solving, and decision-making skills.
Responsibilities
- Examine claim records and forms to investigate and resolve first-level disputes.
- Meet and maintain established quality and production standards.
- Process acknowledgment and determination letters.
- Document actions taken, including dispute decisions and reasoning.
- Create correspondence for the Senior Examiner.
- Work with leadership on improper processing trends and claim-related concerns resulting in disputes.
- Maintain working relationships with team members, interdepartmental staff, and leadership.
- Maintain knowledge of claim processing guidelines, procedures, governing regulations, and compliance requirements.
- Assist with data entry of incoming clean claims when needed.
View Full Description & ApplyYou'll be redirected to the employer's site
