Provider Dispute Resolution Coordinator - Fully remote

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

This is a fully remote position.

The Provider Dispute Resolution Coordinator (“Coordinator”) provides clerical support to the Provider Dispute Resolution (“PDR”) team within Claims and Recovery Department. The Coordinator assists in obtaining appropriate documentations from the provider and/or delegated entities either telephonically or in writing.

General Duties/Responsibilities (May include but are not limited to):

• Provides clerical support to the PDR team which include but not limited to data entry, updating claim processing status codes or indicators, letter printing and/or mailing.
• Contacts provider and/or delegated entities, either telephonically or in writing, for appropriate documentation as requested by the Management and/or PDR Specialists.
• Assists in organizing provider disputes and/or appeals files.
• Tracking and logging of outgoing and incoming correspondence (such as letters, requests sent to the provider or delegated entities and ensure timely responses.
• Provides requested documentation related to disputes or appeals for research and/or audits.
• Assists in validation of disputes and appeals counts
• Understands the differences between disputes and appeals
• Meets and consistently maintains quality and productivity standards as defined by the Management.
• Supports department initiatives in improving processes and workflow efficiencies
• Adheres to all regulatory and company standards, as described in the Employee Handbook and departmental Policies and Procedures.
• Complies with company’s time and attendance policy.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in the department policies and procedures relating to HIPAA Compliance.
• Foster good corporate relations by practicing good customer service principles (i.e., positive attitude, helpful, etc.) and teamwork.
• Performs additional related duties as assigned by Management or designee.

SUPERVISORY RESPONSIBILITIES:

N/A

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

1-2 year experience in claims data entry and clerical position within healthcare claims environment

Education/Licensure:

High School Diploma required

Other:

Working knowledge of claims processing systems (EZCAP a plus)

Knowledge of Medicare claim (a plus)

Understanding of different claim forms

Proficient in using Microsoft Excel and Word

Strong organizational skills

Professional communication skills

Strong customer service orientation both internal and external

Ability to follow oral and written instructions

Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.

Pay Range: $41,600.00 - $57,600.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

• DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.