Provider Dispute Support Specialist

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
• Assist Manager and Supervisor with clerical/administrative tasks relating to the intake and reporting of all Department incoming cases. Assists with distribution of correspondence and internal referrals; and follow up with Department staff and internal departments as directed by management to ensure claims processing and benefit payments are completed consistent with information relayed to providers and within timeframes required by law, regulation, policy or other requirement.
• Forwards Medical Appeals, FEP appeals, and Correspondence to the appropriate departments in a timely manner.
• Assigns tasks to Provider Disputes Specialist based on review and research of the incoming provider disputes.
• Assists with preparing materials for appeal reviews (copying, creation of case binders, coordinate mailing or electronic communications, etc.) and distributing dispute cases and related information to reviewers. This includes ensuring all materials meet minimum necessary rule requirements consistent with internal policies and state/federal privacy laws.
• Assists with creating and maintaining electronic files and hard copy paper files; maintains and tracks department cases and files; assists with preparing and issuing reports required for various internal committee meetings and as needed on an ad hoc basis. Assists with updating database for all dispute cases.
• Assists with maintaining inventory of office supplies, maintain file of receipts and follows-up on outstanding orders.
• Navigates in Facets and Jiva systems to assess claims and authorizations for provider disputes, member appeals and medical appeals. Performs other duties as assigned.