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Provider Dispute Resolution Coordinator-25421 MPK
Monterey Park, California | Contract
EXCITING CONTRACT OPPORTUNITY FOR EXPERIENCED PROVIDER RELATIONS COORDINATOR IN MONTEREY PARK!
Day to Day Responsibilities of this Position and Description of Project:
Review and process provider appeal correspondence accordingly. Read provider contract and determine payment appropriateness. Follow department and company policies and procedures. Send clinical denials to clinical team to review. Contact provider via telephone/fax for additional information as needed. Forward overturned cases to Claims team for payment. Cases must be completed within the regulatory timeframe.
Working knowledge of ICD10-CM, HCPCS level II and III, CPT, and revenue Codes, DRG and APC coding
Working knowledge of different payment methodologies such as Medi-Cal, RBRVS, DRG and other Medicare reimbursements
Ability to comprehend and interpret documents such as provider contracts, procedure manuals, various reports, division of financial responsibility matrix (DOFR)
Knowledge of different claims regulatory requirements such as California Code of Regulations, Title 28 Section 1300.71 Claims Settlement Practices/AB1455, CMS standards as defined in Title 42 Code of Federal Regulations (CFR) section 422 and other Medi-Cal/Medicare Claims Processing guidelines
High School diploma or GED required