Provider Disputes Coordinator

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement. Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. Role Overview Reporting to the Supervisor - Provider Disputes, this position is responsible for the review of provider disputes submitted by providers, the analysis of claims and disputes to determine ownership for resolution and the review of disputes versus member appeals for timely reassignment to appropriate stakeholders. Work Arrangement Remote role Monday through Friday, 8:30 AM EST to 5:00 PM EST Responsibilities Performs administrative tasks, included but not limited to, Fax Management (storage and distribution), letter processing and storage, data collection and assembling/filing completed disputes within provider disputes platform. Manages, adjudicates, and determines ownership of provider disputes submitted from providers, account executives and PCSU. Investigates findings of claim denials and reports underlying reasons for identified data quality issues to management. Participates in quarterly meeting with governing body and reports comprehensive list of data quality issues present during a given period. Communicates with providers to resolve problems with provider dispute requests that are not submitted according to Plan's policy. Maintains an accurate, timely and complete record of provider disputes in a system that tracks the stages of the dispute, how long it takes to resolve the disputes, and manages distribution of the provider disputes to the appropriate stakeholders. Adheres to timely resolution of dispute process as established in current Plan's policy. Collects, analyzes and reviews historical provider dispute information to incorporate into departmental provider dispute documentation. Ensures compliance with record retention plan according to Plan's policy. Coordinates the presentation of the provider disputes to a Provider Disputes Team Lead, Supervisor or manager and participates as a member for a 2nd review. Communicates decisions (either verbally or in writing) made by the Provider Dispute team to providers within Plan timeframe, when necessary. Identifies and reports on provider issues appropriate for use as educational opportunities to the Provider Services management staff. Education and Experience High School Diploma or GED required Associate Degree with an emphasis in health services administration or equivalent experience and education preferred Minimum of 1 year of experience in medical office billing required Medical office and/or claims administration specific to Medicaid Experience working in a productivity based environment Other Skills: Proficiency in MS Office to include Word, Excel, Outlook, Teams Working knowledge of FACETS and/or EXP preferred Proficiency using Electronic Health Records (EHR) Ability to work in a fast paced environment with short turnaround times for deliverables Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.