Central California Alliance for Health
Provider Dispute Coordinator II
Central California Alliance for Health, Santa Cruz, California, us, 95061
Provider Dispute Coordinator IILocation:
Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California
We have an opportunity to join the Alliance as a Provider Dispute Coordinator II in the Claims Quality Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Claims Quality Supervisor, this position:
Coordinates and responds to moderate complexity level one inquiries in the Provider Dispute processAssists with the coordination and completion of low to moderate complexity level two Provider Dispute casesPerforms administrative duties in support of the Claims Quality unit and related functions
WHAT YOU'LL NEED TO BE SUCCESSFUL
Knowledge of:Healthcare coverage and benefit structures, principles of coordination on benefits and medical billingPrinciples and practices of customer serviceThe methods and techniques of research, analysis and reportingWindows based PC systems and Microsoft Word, Excel, and Outlook, and database software
Ability to:Audit information and data, identify anomalies and make recommendations for correctionApply relevant Medi-Cal, Department of Health Care Services, and Centers for Medicare & Medicaid Services claims processing guidelines and regulationsUtilize conflict resolution and problem solving techniquesUnderstand and interpret policies, procedures, and regulationsUnderstand and analyze contractual and regulatory requirements and their application to the resolution of disputes
Education and Experience:High school diploma or equivalentTwo years of experience administering provider disputes or member appeals and grievances or administering provider claims in a managed care setting, health plan, or provider office (an Associate's degree or Medical Assistant Certification issued by a certifying organization approved by the Medical Board of California may substitute for one year of the required experience); or an equivalent combination of training and experience may be qualifying
OTHER INFORMATION
We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
Zone 1 (Monterey, San Benito and Santa Cruz)
$25.60
-
$40.97 USD
Zone 2 (Mariposa and Merced)
$23.30
-
$37.28 USDOUR BENEFITS
Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.
Medical, Dental and Vision PlansAmple Paid Time Off12 Paid Holidays per year401(a) Retirement Plan457 Deferred Compensation PlanRobust Health and Wellness ProgramOnsite EV Charging Stations
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our
Fact Sheet .
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer.
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
#J-18808-Ljbffr
Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California
We have an opportunity to join the Alliance as a Provider Dispute Coordinator II in the Claims Quality Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Claims Quality Supervisor, this position:
Coordinates and responds to moderate complexity level one inquiries in the Provider Dispute processAssists with the coordination and completion of low to moderate complexity level two Provider Dispute casesPerforms administrative duties in support of the Claims Quality unit and related functions
WHAT YOU'LL NEED TO BE SUCCESSFUL
Knowledge of:Healthcare coverage and benefit structures, principles of coordination on benefits and medical billingPrinciples and practices of customer serviceThe methods and techniques of research, analysis and reportingWindows based PC systems and Microsoft Word, Excel, and Outlook, and database software
Ability to:Audit information and data, identify anomalies and make recommendations for correctionApply relevant Medi-Cal, Department of Health Care Services, and Centers for Medicare & Medicaid Services claims processing guidelines and regulationsUtilize conflict resolution and problem solving techniquesUnderstand and interpret policies, procedures, and regulationsUnderstand and analyze contractual and regulatory requirements and their application to the resolution of disputes
Education and Experience:High school diploma or equivalentTwo years of experience administering provider disputes or member appeals and grievances or administering provider claims in a managed care setting, health plan, or provider office (an Associate's degree or Medical Assistant Certification issued by a certifying organization approved by the Medical Board of California may substitute for one year of the required experience); or an equivalent combination of training and experience may be qualifying
OTHER INFORMATION
We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
Zone 1 (Monterey, San Benito and Santa Cruz)
$25.60
-
$40.97 USD
Zone 2 (Mariposa and Merced)
$23.30
-
$37.28 USDOUR BENEFITS
Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.
Medical, Dental and Vision PlansAmple Paid Time Off12 Paid Holidays per year401(a) Retirement Plan457 Deferred Compensation PlanRobust Health and Wellness ProgramOnsite EV Charging Stations
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our
Fact Sheet .
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer.
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
#J-18808-Ljbffr