Provider Dispute Resolution Coordinator, Intermediate

Your Role The Provider Dispute Resolution Team is seeking an Intermediate Provider Dispute Resolution Coordinator. This role involves researching, reviewing, and adjusting high-priority and high-dollar provider grievances, appeals, and complaints, while clarifying issues and educating providers about the No Surprise Billing mandate. The Coordinator reports to the PDR Operations Manager and should be capable of making independent decisions and 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 similar background Experience with claims processing, including adjustments, interest accuracy, general suspense, and back-end claims Strongly preferred: experience in Commercial LOB claims and/or appeals Preferred: experience with Medi-Cal and/or Medicare LOB claims and/or appeals Preferred: experience with No Surprise Billing Preferred knowledge of applicable legislation, regulations, and compliance standards Familiarity with 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 free-format letter writing

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