Provider Dispute Resolution Specialist

Job Summary

A company is looking for a Provider Dispute Resolution Specialist who will be responsible for reviewing, researching, and resolving provider disputes in compliance with regulatory guidelines and internal policies.

Key Responsibilities

• Investigate and resolve provider disputes related to denied, underpaid, or incorrectly processed claims
• Utilize EZCap to review claims history, adjudication data, and notes
• Document findings and resolutions according to compliance standards

Required Qualifications

• High school diploma or equivalent; associate or bachelor's degree is a plus
• 1-2 years of provider dispute resolution experience in healthcare or claims processing environments
• Hands-on experience with EZCap is strongly preferred
• Familiarity with Medi-Cal and Commercial insurance claims
• Ability to manage multiple tasks and meet deadlines