Texas Provider Dispute Specialist

Job Summary

A company is looking for a Provider Dispute & Open Negotiation Specialist.

Key Responsibilities

• Manage provider disputes from intake through final resolution, ensuring compliance with regulatory timeframes
• Serve as the primary contact for open negotiation cases, coordinating submissions and managing compliance with state and federal regulations
• Analyze dispute trends and collaborate on process improvements and training needs based on findings

Required Qualifications

• 3-5 years of experience in a commercial health plan environment, focusing on claim adjudication and provider disputes
• Strong knowledge of Texas open negotiation and federal IDR processes under the No Surprises Act
• Understanding of the differences between state-regulated and federally regulated dispute frameworks
• Proficiency in claims processing systems and basic data analysis tools
• Experience drafting professional provider responses