appeals and provider dispute specialist
Posted 1 day ago by 1769672321
Negotiable
Outside
Remote
irving, texas (remote)
Summary: The Appeals & Provider Dispute Specialist is responsible for managing complex reconsideration requests within the Medicaid Line of Business, focusing on the research, investigation, and resolution of provider appeals. This role requires analytical skills to ensure clinical and financial accuracy while making key decisions in the dispute lifecycle. The position utilizes specific systems to assess claim denials and determine their validity. The role is remote and based in Irving, Texas.
Key Responsibilities:
- Manage complex reconsideration requests within the Medicaid Line of Business.
- Conduct comprehensive research and investigation of provider appeals.
- Ensure clinical and financial accuracy in the resolution of disputes.
- Utilize CenPAS and AMISYS to assess claim denials.
- Make key decisions in the dispute lifecycle.
Key Skills:
- Strong analytical skills.
- Experience with Medicaid processes.
- Proficiency in using CenPAS and AMISYS.
- Ability to manage complex disputes.
- Excellent research and investigation skills.
Salary (Rate): £17.60 hourly
City: Irving
Country: United States
Working Arrangements: remote
IR35 Status: outside IR35
Seniority Level: undetermined
Industry: Other
We are seeking a highly analytical Appeals & Provider Dispute Specialist to manage complex reconsideration requests within our client's Medicaid Line of Business. This role is dedicated to the comprehensive research, investigation, and resolution of provider appeals to ensure clinical and financial accuracy. You will serve as a key decision-maker in the dispute lifecycle, utilizing CenPAS and AMISYS to determine if initial claim denials should be upheld or