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Provider Dispute Resolution Coordinator-25421 MPK

Monterey Park, California | Contract

Job ID: 55503 Position: Administrative/Clerical/Support Branch: Torrance

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.

REQUIREMENTS:

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

Rachel Savitt
Staffing Manager

Rachel rejoined the Wollborg Michelson Recruiting team in Torrance as the Staffing Manager. She previously worked for the company from 2006-2009 as a Recruiter for the Temporary division. Rachel brings over 16 years of Staffing Industry experience. She has worked on all sides of the industry as a temporary employee, client, full desk Recruiter as well as corporate for a Staffing Company. Her goal is to change the lives of everyone she works with no matter what their role. In her free time, Rachel enjoys spending time with her friends and family. She is active with multiple non-profit animal rescues and prefers to ask for donations instead of gifts for birthday. She also enjoys kickboxing, Muay Thai and dancing. Rachel always finds a way to connect with people. Her #1 Strength from Strengthfinders is Connectedness.

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