Provider Dispute Resolution Coordinator - Fully remote

Alignment Healthcare•Orange, CA

3d•Remote

About The Position

Alignment Health is seeking a Provider Dispute Resolution Coordinator to provide clerical support to the Provider Dispute Resolution (PDR) team within the Claims and Recovery Department. This fully remote position involves assisting in obtaining appropriate documentation from providers and/or delegated entities telephonically or in writing. Alignment Health is dedicated to serving seniors and the chronically ill, offering opportunities for growth and innovation in a fast-paced environment where employees can make a real difference.

Requirements

1-2 years of experience in claims data entry and a clerical position within a healthcare claims environment.
High School Diploma required.
Working knowledge of claims processing systems (EZCAP a plus).
Knowledge of Medicare claims (a plus).
Understanding of different claim forms.
Proficient in using Microsoft Excel and Word.
Strong organizational skills.
Professional communication skills.
Strong customer service orientation both internal and external.
Ability to follow oral and written instructions.

Nice To Haves

EZCAP experience
Knowledge of Medicare claims
Understanding of different claim forms

Responsibilities

Provides clerical support to the PDR team, including data entry, updating claim processing status codes or indicators, and letter printing/mailing.
Contacts providers and/or delegated entities telephonically or in writing for appropriate documentation as requested by management or PDR Specialists.
Assists in organizing provider disputes and/or appeals files.
Tracks and logs outgoing and incoming correspondence, ensuring timely responses.
Provides requested documentation related to disputes or appeals for research and/or audits.
Assists in the validation of disputes and appeals counts.
Understands the differences between disputes and appeals.
Meets and consistently maintains quality and productivity standards.
Supports department initiatives in improving processes and workflow efficiencies.
Adheres to all regulatory and company standards.
Complies with company’s time and attendance policy.
Ensures the privacy and security of PHI (Protected Health Information) as outlined in departmental policies and procedures relating to HIPAA Compliance.
Fosters good corporate relations by practicing good customer service principles and teamwork.
Performs additional related duties as assigned by Management or designee.