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    Provider Disputer Resolution - Los Angeles, United States - MedPOINT Management

    MedPOINT Management
    MedPOINT Management Los Angeles, United States

    1 week ago

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    Description

    Job Description

    Job Description

    Summary:

    As a Provider Dispute Resolution Examiner, you 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. You will collaborate with providers, internal teams, and external stakeholders to ensure that disputes are resolved in accordance with industry standards and regulatory requirements.

    Duties and Responsibilities:

    · Meets production standards of 20-30 Hospital Provider Dispute claims per day and 50-75 IPA Provider Dispute claims as established by claims management.

    · Assists in other IPA's when needed.

    · Submits automation requests through SharePoint.

    · Processes Customer Services Inquiries.

    · Assists with training new hires.

    · Continue with ongoing training to further Claims Adjudication knowledge

    · Performs other tasks as assigned by supervisor/manager.

    · Attends training meetings and asks questions.

    · Provides auditor with training suggestions/examples.

    · Adhere to Claims Department policies and procedures. Keeps updated materials and resources provided for accurate and expedient adjudication.

    · Ensure that the Examiner's Checklist is verified and done.

    · Provide auditor examples of examiner errors.

    Minimum Job 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 II

    Skills and Abilities:

    · Must be able to communicate with others clearly, tactfully, and professionally.

    · Must have strong computer skills with a broad knowledge of software packages. Must be able to follow directions and perform independently according to departmental standards when no directions are given.

    · Must possess effective communication skills. Must be able to willingly accept responsibility and possess the desire to learn new tasks.

    · Must have strong organizational and mathematical skills.

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