Provider Disputes Analyst — Health Plan Solutions

Gold Coast Health Plan; California (MO); In loco; USD 44.000 - 62.000; Tempo pieno

Descrizione del lavoro

Gold Coast Health Plan is seeking an experienced Provider Disputes Analyst to investigate, analyze, and resolve provider disputes in compliance with regulatory requirements and contracts. You will research claims, review documentation, and coordinate across departments to ensure timely resolution.

The role requires knowledge of Medi-Cal, Medicare, and related reimbursement methodologies, with a focus on accuracy, communication, and adherence to policies. A high school diploma is required.

Competenze

• High School diploma or GED required.
• Knowledge of Medi-Cal and Medicare preferred.
• Experience with claims processing and provider disputes a plus.
• Strong analytical and communication skills.

Mansioni

• Investigate, analyze, and resolve provider disputes in accordance with regulatory requirements.
• Research claims, payment history, benefits, contracts to determine resolution.
• Process provider disputes within regulatory timeframes.
• Coordinate with multiple departments to facilitate timely resolution.
• Document findings and communicate status to providers.

Conoscenze

Dispute resolution

Claims processing

Regulatory knowledge

Data analysis

MS Office

Formazione

High School Diploma/GED

Descrizione del lavoro

Gold Coast Health Plan is seeking an experienced Provider Disputes Analyst to investigate, analyze, and resolve provider disputes in compliance with regulatory requirements and contracts. You will research claims, review documentation, and coordinate across departments to ensure timely resolution.

The role requires knowledge of Medi-Cal, Medicare, and related reimbursement methodologies, with a focus on accuracy, communication, and adherence to policies. A high school diploma is required.