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    Provider Dispute Resolution Analyst - Los Angeles, United States - University of California

    University of California
    University of California Los Angeles, United States

    3 weeks ago

    Default job background
    Description
    Take on a key role within a world-class, award-winning health system. Elevate the operational effectiveness of an award-winning healthcare leader. Take your career in an exciting new direction. You can do all this and more at UCLA Health.
    You will be responsible for the accurate analysis and resolution of provider disputes.

    This will require extensive knowledge of CMS Medicare Advantage regulatory requirements, Department of Financial Responsibility (DOFR) provisions, and internal operation requirements, policies, and procedures.


    You will:

    • Review and process provider dispute resolutions according to state and federal designated timeframes
    • Research and respond to provider inquiries related to claims payments
    • Research reported issues; adjust claims and determine the root cause of the dispute
    • Draft written responses to providers in a professional manner within required timeliness
    • Ensure the accurate and timely processing of PDR documents
    • Serve as subject matter expertise in evaluating and responding to all provider disputes
    • Analyze complex post-paid healthcare claims
    • Apply in-depth research to determine accuracy and mitigate payment errors
    • Communicate with external and internal providers, both verbally and in writing related to the cases under review
    • Coordinate with other departments as necessary to facilitate resolution of claim related issues.
    Identify and report claim related claim issues for provider education

    Salary Range:
    $ $48.04 Hourly

    Qualifications We're seeking a self-motivated, detail-oriented, deadline-driven individual with:

    • Five or more years of healthcare claim processing experience in a managed care environment
    • One or more years of experience with provider disputes
    • Experience processing PDR documents
    • Ability to interpret provider contracts and apply them to claims adjudication
    • Computer proficiency with Microsoft Office
    • Strong math, communication, analytical, critical-thinking, and problem-solving skills
    • Knowledge of medical terminology, claim forms, and physician billing coding
    • Ability to read/interpret contracts, standard reference materials, etc.

    UCLA Health is a world-renowned health system with four award-winning hospitals and more than 260 community clinics throughout Southern California.

    We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles' trusted provider of exceptional, compassionate patient care. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.
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