Provider Dispute Resolution Specialist - Hybrid - 141256

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

This position has recently been accreted by UAW RP union and will be a part of that union moving forward.

This position will work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive (San Diego, CA) and remote.

DESCRIPTION

Responsible for end-to-end claims appeal process including, but not limited to, claim appeal intake, categorization, acknowledgement, resolution, documentation, provider notification, claim reprocessing, tracking, trending and reporting.

MINIMUM 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. Related experience: processing professional and facility claims within Epic Tapestry.
• 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.

PREFERRED QUALIFICATIONS

• Experience reviewing, approving and denying claim appeals in Epic Tapestry.
• Experience interpreting Division of Financial Responsibility (DOFR) agreements and delegated claims payment responsibilities.
• Knowledge of California provider dispute resolution requirements and managed care regulatory standards.

SPECIAL CONDITIONS

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.

Pay Transparency Act

Annual Full Pay Range: Unclassified - No data available (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: Unclassified - No data available

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).