Provider Inquiry Coordinator

Doctors Healthcare Plans•Coral Gables, FL

About The Position

Research and resolve claims disputes coming from Participating providers. This role involves navigating company claims systems and multiple platforms to ensure timely, efficient, accurate, and compliant resolution of claim disputes. The coordinator will also identify opportunities for process improvement, review dispute reports, handle provider communications, and collaborate with internal departments.

Requirements

Minimum experience of 3 years in healthcare operations
Experience with Medicare Advantage regulatory requirements
Knowledge of Professional and Facility claims and claim disputes, provider compensation, benefits, coding and medical terminology
Solid organizational and administrative skills
Able to thrive in a high-pressure environment
Written and oral communication skills
Computer literacy and advanced Excel spreadsheets for operational data analysis and reporting

Responsibilities

Research and resolve claim disputes by navigating company’s claims system and multiple platforms
Ensure timely, efficient, accurate and compliant resolution of claim disputes
Research provider contract, fee-schedules, claim rules, correct application of benefits, prior authorizations and member eligibility as they relate to claim disputes
Identify opportunities to improve claims processing, and reduce risk and inefficiency
Review claim dispute reports for data integrity and perform necessary updates
Perform data entry of claims disputes
Handle provider telephone calls and e-mails regarding the status of claim disputes
Work with the Provider Relations team and support claim dispute escalations
Communicate with internal departments as required
Meet performance metrics and goals established for the position
Performs additional duties and responsibilities as assigned by management