Dispute Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $70.3k - $81.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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WelbeHealth

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $30M Series C on 2020-02

Healthcare • Healthcare Insurance

WelbeHealth is a healthcare organization that provides comprehensive medical care and personalized support to help seniors age well at home and in their communities. They offer a Program of All-Inclusive Care for the Elderly (PACE) which includes services such as medical care and coordination, dental, vision and hearing services, in-home care, prescription deliveries, transportation, physical therapy, meals, social activities, and more, often at no cost to eligible seniors. WelbeHealth's dedicated team prioritizes the needs of seniors by offering a coordinated approach to healthcare, ensuring access to highly skilled professionals across various areas of healthcare, and emphasizing patient-centered care. Their goal is to improve the quality of life for seniors by enabling them to live independently with robust support from a multidisciplinary team.

📋 Description

• Investigate and resolve first-level disputes involving claim payments, claim denials, and contractual agreements • Examine claim records and forms while meeting established quality and production standards • Complete acknowledgment and determination letters • Provide detailed notes on dispute decisions and reasoning • Create correspondence for the Senior Examiner • Work with leadership on improper processing trends and claim-related concerns • Maintain effective relationships with team members, interdepartmental staff, and leadership • Maintain knowledge of claim processing guidelines, procedures, regulations, and compliance requirements • Assist with data entry of incoming clean claims as needed • Educate providers on proper processing and promote provider satisfaction

🎯 Requirements

• High school diploma or equivalency; professional experience may be substituted • Experience in a Managed Care Plan (MCP) or PACE organization (PO) claims processing environment • Minimum of three (3) years of health plan claims processing experience • Two (2) years of health plan claims dispute experience analyzing and resolving provider claims • Strong computer and software knowledge, including Excel, Outlook, PowerPoint, Word, Teams, and job-specific applications/systems • Ability to navigate state/federal websites and medical billing guidelines • Excellent verbal and written communication skills • Organizational and time management skills • Problem solving and decision-making skills • Proof of COVID-19 vaccination or a vaccine declination form required prior to employment

🏖️ Benefits

• Medical insurance coverage (Medical, Dental, Vision) • 17 days of personal time off (PTO) • 12 holidays observed annually • Sick time • 401K savings + match • Advancement opportunities • Additional benefits • COVID-19 vaccination policy with proof of vaccination or a vaccine declination form required prior to employment • Infection control and PPE standards