Provider Dispute Resolution Specialist

LSMA Management Inc • San Bernardino, CA

3h • Onsite

About The Position

The Provider Dispute Resolution Specialist is responsible for the accurate, timely, and compliant review and resolution of provider disputes and appeals related to claims adjudication, reimbursement, coding, and authorization determinations. This role ensures compliance with applicable California state and federal regulations, contractual obligations, and internal policies while supporting positive provider relations.

Requirements

• High school diploma or equivalent.
• 5+ years of experience processing managed care health claims.
• Strong working knowledge of managed care claims operations and regulatory requirements, including dispute and appeal timeliness standards.
• Proficiency with medical coding concepts (ICD-10, CPT, HCPCS, DRG, ASC).
• Experience with UB-04 and CMS-1500 claim forms.
• Ability to analyze complex data, identify discrepancies, and apply contract terms accurately.
• Strong written and verbal communication skills in English.
• Effective time management skills with the ability to manage competing priorities and workload volumes.
• Intermediate proficiency with Microsoft Office applications, including Word and Excel.
• Demonstrated problem-solving skills and attention to detail.

Nice To Haves

• Coursework or training in healthcare administration, medical billing, or related field.
• 2+ years of direct Provider Dispute Resolution and/or Appeals experience within Medicare, Medi-Cal/Medicaid, Commercial, PPO, and/or HMO environments.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED