Provider Dispute Resolution Specialist (Hybrid)

University of California - San Diego Medical Centers; San Diego (CA); Hybrid; USD 60,000 - 80,000; Full time

Job summary

University of California - San Diego Medical Centers is seeking a claims appeals professional to manage end-to-end processes in a hybrid environment, including onsite at Greenwich Drive and remote work in San Diego, CA. The role requires substantial experience with Epic Tapestry, strong data analysis skills, and meticulous attention to detail.

Responsibilities include intake, categorization, acknowledgement, resolution, provider notification, reprocessing, tracking and reporting on trends.

Qualifications

• Six (6) years of related experience, education/training, OR a Bachelor's degree in related area plus two (2) years of related experience/training.
• Working knowledge of common organization- or research-specific and other computer application programs.
• Proficient in communication and interpersonal skills to communicate effectively, both verbally and in writing.
• Proficient in ability to use discretion and maintain all confidentiality.
• Demonstrates ability to use sound judgment in responding to issues and concerns.
• Demonstrates ability to analyze, research and synthesize large amounts of data with strong attention to detail.
• Proficient in ability to multi-task with demanding timeframes.
• Working knowledge of applicable policy analysis techniques.

Responsibilities

• Responsible for end-to-end claims appeal process including intake, categorization, acknowledgement, resolution, documentation, provider notification, claim reprocessing, tracking, trending and reporting.
• Document outcomes and communicate with providers, health plans and stakeholders.
• Maintain confidentiality and ensure compliance with applicable policies and procedures.

Skills

Claims processing

Epic Tapestry

Data analysis

Communication

Confidentiality

Education

Bachelor's degree in related area

Six years of related experience or Bachelor's + 2 years

Tools

Epic Tapestry

MS Office

Job description

University of California - San Diego Medical Centers is seeking a claims appeals professional to manage end-to-end processes in a hybrid environment, including onsite at Greenwich Drive and remote work in San Diego, CA. The role requires substantial experience with Epic Tapestry, strong data analysis skills, and meticulous attention to detail.

Responsibilities include intake, categorization, acknowledgement, resolution, provider notification, reprocessing, tracking and reporting on trends.