Brighton Health Plan Solutions
Claim Dispute Specialist
Brighton Health Plan Solutions, New York, New York, United States, 10001
Claim Dispute Specialist
Brighton Health Plan Solutions (BHPS) is seeking an experienced Claim Dispute Specialist skilled in investigating and resolving provider payment disputes by our members and providers. Responsible for ensuring all determination responses are compliant with all established regulations. Primary Responsibilities
Thorough review of claims and medical documentation. Prepare cases for clinical review. Resolve and provide accurate and timely responses to disputes and all other correspondence. Communicate effectively with individuals/teams to ensure high quality and timely expedition of customer requests. Research and document pertinent information on claims requiring adjudication. Assist Customer Service in responding to and resolving customer questions and concerns related to correspondence. Contribute ideas on ways to resolve problems to better serve the customer and/or improve productivity. Solve problems that are sometimes unstructured and that may require reliance on conceptual thinking. Maintain broad knowledge of client products and services. Essential Qualifications
Strong knowledge of contracts, medical terminology, and claim dispute processing and procedures. Previous experience handling claim disputes. Claim knowledge including professional, facility and ancillary claims. Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required. Ability to meet expected production and quality standards. Proficient in Microsoft Office Suite- specifically Microsoft Word and Microsoft Excel. Ability to maintain a professional demeanor under pressure. Capable of managing multiple complex issues. Strong knowledge of contracts, medical terminology, and appeals processing and procedures. High School Diploma or GED diploma; some college or business school education is a plus. About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you'll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you'll be encouraged to bring your authentic self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today's healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today's challenges into tomorrow's solutions. Come be a part of the Brightest Ideas in Healthcare. Company Mission
Transform the health plan experience
how health care is accessed and delivered
by bringing outstanding products and services to our partners. Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways. DEI Purpose Statement
At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion, and a sense of belonging at every level. *We are an Equal Opportunity Employer Annual Salary Range: $45,000 - $55,000
Brighton Health Plan Solutions (BHPS) is seeking an experienced Claim Dispute Specialist skilled in investigating and resolving provider payment disputes by our members and providers. Responsible for ensuring all determination responses are compliant with all established regulations. Primary Responsibilities
Thorough review of claims and medical documentation. Prepare cases for clinical review. Resolve and provide accurate and timely responses to disputes and all other correspondence. Communicate effectively with individuals/teams to ensure high quality and timely expedition of customer requests. Research and document pertinent information on claims requiring adjudication. Assist Customer Service in responding to and resolving customer questions and concerns related to correspondence. Contribute ideas on ways to resolve problems to better serve the customer and/or improve productivity. Solve problems that are sometimes unstructured and that may require reliance on conceptual thinking. Maintain broad knowledge of client products and services. Essential Qualifications
Strong knowledge of contracts, medical terminology, and claim dispute processing and procedures. Previous experience handling claim disputes. Claim knowledge including professional, facility and ancillary claims. Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required. Ability to meet expected production and quality standards. Proficient in Microsoft Office Suite- specifically Microsoft Word and Microsoft Excel. Ability to maintain a professional demeanor under pressure. Capable of managing multiple complex issues. Strong knowledge of contracts, medical terminology, and appeals processing and procedures. High School Diploma or GED diploma; some college or business school education is a plus. About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you'll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you'll be encouraged to bring your authentic self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today's healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today's challenges into tomorrow's solutions. Come be a part of the Brightest Ideas in Healthcare. Company Mission
Transform the health plan experience
how health care is accessed and delivered
by bringing outstanding products and services to our partners. Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways. DEI Purpose Statement
At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion, and a sense of belonging at every level. *We are an Equal Opportunity Employer Annual Salary Range: $45,000 - $55,000