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Job Offer: provider dispute resolution specialist:Randstad

Job description:

job details

posted
   . Thursday, July 12, 2018
location
   . ontario, california
job category
   . Administrative & Support Services
job type
   . temporary
income
   . US$ 21 per hour
reference number
   . S_662186
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job description

Duration: 07/16/2018 to 10/15/2018 (Temp to Hire)
Hours: M-F 7:30am-4:30pm
Pay: $21.00/hr

Job responsibilities:
Specific tasks:
1.Reviews written dispute requests received from providers of denied or incorrect payments located on contractual arrangements with providers and non-contractual providers. Regarding either Professional or Institutional Claims.
2. capability to interpret provider and health plan contracts to ensure accurate payment of claims or denial of services located on the terms of the provider contract and the financial responsibility as set in the health plan contract. Including RBRVS and Medicare guidelines as Information technology applies to contracted and non-contracted providers.
3.Adjust claims, as appropriate, including calculation of interest and penalties due when applicable.
4.capability to identify potential issues related to system configuration, benefits, eligibility, authorizations, etc. affecting the Claims Departments capability to process claims accurately and forwarding those issues to the correct internal department, attaching all necessary documentation, to ensure the system is updated, as appropriate and follow-up with these departments.
5.Plan and organize workload to ensure efficient and compliance resolution of issues.
6.Communicate to Provider in writing, for all disputes utilizing system formatted letters in a clear and concise manner in conformity with all guidelines set by the department
7. Responsible for requesting special check run requests to insure compliance
8.Warning reports are monitored everyday to insure compliance
9. Provider education calls completed located on results of PDR
10. Responsible for documenting each dispute in Provider Dispute Database accurately for reporting purposes for management reports to all customers internally and externally as required by AB1455.

Working hours: 7:30 AM - 4:30 PM

expertise:
Must have qualifications/practice:
1.High school diploma or a general education degree.
2.Minimum of three to five years' practice as a Claims Examiner with previous Medicare and HMO practice.
3.Previous auditing and appeals practice preferred
4. Working expertise of medical terminology, ICD9, ICD 10, CPT4, HCPCs
5. Working expertise of UB04 and CMS 1500 Forms
6. capability to effectively interpret provider contract language and provisions
7. broad HMO expertise
8. Familiar with AB1455, Knox Keene Act, Federal Register and Medicare Guidelines and Regulations
9. capability to communicate effectively
10. Excellent grammatical and letter writing expertise; in adherence to regulatory guidelines
11. Excellent analytic expertise needed.
12. Must be flexible, self starter, team player
13. capability to stringently manage, decipher and adhere to Regulatory timeframes for PDR and CMS Dispute processing.
14. Working expertise of Revenue and HCPCS coding practices
15. Must be able to work independently and solve moderately complex issues with limited supervision.

Appropriate qualifications:
Please mail your CV to janelle.forystek@randstadusa.com

Randstad is a world leader in matching great people with great companies. Our practiced agents will listen carefully to your employment needs and then work diligently to match your expertise and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Discapability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.San Francisco Fair Chance Ordinance:Qualified candidates in San Francisco with criminal histories will be considered for employment in conformity with the San Francisco Fair Chance Ordinance.

expertise

Must have qualifications/practice: 1.High school diploma or a general education degree. 2.Minimum of three to five years' practice as a Claims Examiner with previous Medicare and HMO practice. 3.Previous auditing and appeals practice preferred 4. Working expertise of medical terminology, ICD9, ICD 10, CPT4, HCPCs 5. Working expertise of UB04 and CMS 1500 Forms 6. capability to effectively interpret provider contract language and provisions 7. broad HMO expertise 8. Familiar with AB1455, Knox Keene Act, Federal Register and Medicare Guidelines and Regulations 9. capability to communicate effectively 10. Excellent grammatical and letter writing expertise; in adherence to regulatory guidelines 11. Excellent analytic expertise needed. 12. Must be flexible, self starter, team player 13. capability to stringently manage, decipher and adhere to Regulatory timeframes for PDR and CMS Dispute processing. 14. Working expertise of Revenue and HCPCS coding practices 15. Must be able to work independently and solve moderately complex issues with limited supervision.

qualification

Please mail your CV to janelle.forystek@randstadusa.com

responsibilities

Specific tasks: 1.Reviews written dispute requests received from providers of denied or incorrect payments located on contractual arrangements with providers and non-contractual providers. Regarding either Professional or Institutional Claims. 2. capability to interpret provider and health plan contracts to ensure accurate payment of claims or denial of services located on the terms of the provider contract and the financial responsibility as set in the health plan contract. Including RBRVS and Medicare guidelines as Information technology applies to contracted and non-contracted providers. 3.Adjust claims, as appropriate, including calculation of interest and penalties due when applicable. 4.capability to identify potential issues related to system configuration, benefits, eligibility, authorizations, etc. affecting the Claims Departments capability to process claims accurately and forwarding those issues to the correct internal department, attaching all necessary documentation, to ensure the system is updated, as appropriate and follow-up with these departments. 5.Plan and organize workload to ensure efficient and compliance resolution of issues. 6.Communicate to Provider in writing, for all disputes utilizing system formatted letters in a clear and concise manner in conformity with all guidelines set by the department 7. Responsible for requesting special check run requests to insure compliance 8.Warning reports are monitored everyday to insure compliance 9. Provider education calls completed located on results of PDR 10. Responsible for documenting each dispute in Provider Dispute Database accurately for reporting purposes for management reports to all customers internally and externally as required by AB1455.

educational requirements

High School

Skills:

Job Category: Other [ View All Other Jobs ]
Language requirements:
Employment type:
Salary: Unspecified
Degree: Unspecified
Experience (year): Unspecified
Job Location: Ontario, California
Company Type Employer
Post Date: 07/12/2018 / Viewed 14 times
Contact Information
Company: Randstad
Contact Email: janelle.forystek@randstadusa.com


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