Provider Inquiry Coordinator

Position Purpose

Research and resolve claims disputes coming from Participating providers.

Responsibilities

• Navigate company’s claims system and multiple platforms to research and resolve claim disputes
• Ensure timely, efficient, accurate and compliant resolution of claim disputes
• Research provider contract, fee-schedules, claim rules, correct application of benefits, prior authorizations and member eligibility as they relate to claim disputes
• Identify opportunities to improve claims processing, and reduce risk and inefficiency
• Review claim dispute reports for data integrity and perform necessary updates
• Perform data entry of claims disputes
• Handle provider telephone calls and e-mails regarding the status of claim disputes
• Work with the Provider Relations team and support claim dispute escalations
• Communicate with internal departments as required
• Maintain performance metrics and goals established for the position

Requirements

• Minimum experience of 3 years in healthcare operations
• Experience with Medicare Advantage regulatory requirements
• Knowledge of Professional and Facility claims and claim disputes, provider compensation, benefits, coding and medical terminology
• Solid organizational and administrative skills
• Able to thrive in a high-pressure environment
• Written and oral communication skills
• Computer literacy and advanced Excel spreadsheets for operational data analysis and reporting