AmeriHealth Caritas Coordinator Provider Disputes in Charleston, South Carolina
Coordinator Provider Disputes
Location: Charleston, SC
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Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
Reporting to the Supervisor - Provider Disputes, this position is responsible for the review of provider disputes submitted by providers, the analysis of claims and disputes to determine ownership for resolution and the review of disputes versus member appeals for timely reassignment to appropriate stakeholders.
Performs administrative tasks, included but not limited to, Fax Management (storage and distribution), letter processing and storage, data collection and assembling/filing completed disputes within provider disputes platform.
Manages, adjudicates, and determines ownership of provider disputes submitted from providers, account executives and PCSU. Investigates findings of claim denials and reports underlying reasons for identified data quality issues to management
Participates in quarterly meeting with governing body and reports comprehensive list of data quality issues present during a given period.
Communicates with providers to resolve problems with provider dispute requests that are not submitted according to Plan’s policy.
Maintains an accurate, timely and complete record of provider disputes in a system that tracks the stages of the dispute, how long it takes to resolve the disputes, and manages distribution of the provider disputes to the appropriate stakeholders.
Adheres to timely resolution of dispute process as established in current Plan’s policy.
Collects, analyzes and reviews historical provider dispute information to incorporate into departmental provider dispute documentation.
Ensures compliance with record retention plan according to Plan’s policy.
Coordinates the presentation of the provider disputes to a Provider Disputes Team Lead, Supervisor or manager and participates as a member for a 2nd review.
Communicates decisions (either verbally or in writing) made by the Provider Dispute team to providers within Plan timeframe, when necessary.
Identifies and reports on provider issues appropriate for use as educational opportunities to the Provider Services management staff
Other duties as assigned by management.
Bachelor’s Degree preferred w/emphasis in health services administration or equivalent exp in medical office admin and/or claims admin, especially Medicaid billing.
3-5 years medical office billing experience.
Proficiency in MS Word, Excel & Powerpoint.
EOE Minorities/Females/Protected Veterans/Disabled