MedStar Health
Your Role
The Provider Dispute Resolution Team is seeking an Intermediate Provider Dispute Resolution Coordinator to research, review, and resolve high-priority, high-dollar provider grievances, appeals, and complaints. The role involves 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 prioritization are essential to meet compliance timeframes and project deadlines.
Your Knowledge and Experience
- High school diploma or GED required
- Minimum of 2 years experience in health insurance operations such as I&M, Claims, Customer Service, Regulatory Affairs, and/or Appeals/Grievances
- Claims processing experience, including adjustments, interest accuracy, suspense, and back-end claims
- Strongly preferred experience in Commercial Line of Business (LOB) claims and/or appeals
- Preferred experience in Medi-Cal and/or Medicare LOB claims and/or appeals
- Preferred experience with No Surprise Billing
- Knowledge of applicable legislation, regulations, and compliance is preferred
- 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 drafting free-format letters is preferred
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