Provider Dispute Resolution Specialist

posted on April 26, 2022

Job Description

Location: United States

Duration: 6 months


  • #LI-Remote
  • 3+ years experience processing Medicare Advantage provider appeals from all types of providers (hospitals, physicians, ancillary)
  • 3+ years experience in examining all types of medical claims, preferably Medicare Advantage claims
  • Education/Licensure: High School Diploma required & Bachelor’s Degree in related field, a plus
  • Working knowledge of claims processing systems (EZCAP preferred)
  • Working knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-9, ICD-10, DRG, etc.
  • Understanding of different payment methodology such as Medicare PPS (MS-DRG, APC, etc.), Medicare Physicians fee schedule, Per Diem, etc.,
  • Understanding of Division of Financial Responsibility on how they apply to claims processing
  • Familiarity with billing and coding edits, coordination of benefits, MA Organization, Determination, Appeals and Grievance procedures
  • Proven problem-solving skills and ability to translate knowledge to the department
  • Working knowledge of Microsoft Office Programs (Outlook, Excel and Word)
  • Excellent verbal and written communication skills
  • Strong Organizational Skill and ability to multitask
  • Attention to Detail
  • Ability to use 10 keys


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