MedStar Health
Provider Dispute Resolution Coordinator, Intermediate
MedStar Health, San Diego, California, United States, 92189
Your Role
The Provider Dispute Resolution Team is seeking an
Intermediate Provider Dispute Resolution Coordinator
to research, review, and resolve high-priority and high-dollar provider grievances, appeals, and complaints. This role involves clarifying issues and educating providers about the No Surprise Billing mandate. The Coordinator will report to the PDR Operations Manager and should be capable of making independent decisions regarding appeal determinations. Effective time management and workload prioritization are essential to meet compliance timeframes and project deadlines. Your Knowledge and Experience High school diploma or GED required Minimum of 2 years of experience in health insurance operations such as I&M, Claims, Customer Service, Regulatory Affairs, and/or Appeals/Grievances, or a related field Experience with claims processing, including adjustments, interest accuracy, general suspense, and back-end claims Strongly preferred experience in Commercial Line of Business (LOB) claims and/or appeals Preferred experience with Medi-Cal and/or Medicare LOB claims and/or appeals Preferred knowledge of No Surprise Billing regulations Familiarity with relevant legislation, regulations, and compliance standards Knowledge of systems such as Facets, DocDNA, Smartcomm, Documentum, CLMS, CMS Pricers (3M Pricer, DRG Pricer, SNF Pricer), and CareWebQI is preferred Proficiency in Microsoft Office applications Experience in writing free-format letters
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Intermediate Provider Dispute Resolution Coordinator
to research, review, and resolve high-priority and high-dollar provider grievances, appeals, and complaints. This role involves clarifying issues and educating providers about the No Surprise Billing mandate. The Coordinator will report to the PDR Operations Manager and should be capable of making independent decisions regarding appeal determinations. Effective time management and workload prioritization are essential to meet compliance timeframes and project deadlines. Your Knowledge and Experience High school diploma or GED required Minimum of 2 years of experience in health insurance operations such as I&M, Claims, Customer Service, Regulatory Affairs, and/or Appeals/Grievances, or a related field Experience with claims processing, including adjustments, interest accuracy, general suspense, and back-end claims Strongly preferred experience in Commercial Line of Business (LOB) claims and/or appeals Preferred experience with Medi-Cal and/or Medicare LOB claims and/or appeals Preferred knowledge of No Surprise Billing regulations Familiarity with relevant legislation, regulations, and compliance standards Knowledge of systems such as Facets, DocDNA, Smartcomm, Documentum, CLMS, CMS Pricers (3M Pricer, DRG Pricer, SNF Pricer), and CareWebQI is preferred Proficiency in Microsoft Office applications Experience in writing free-format letters
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