Provider Disputes & Appeals Coordinator

Tier4 Group; Baton Rouge (LA); On-site; USD 42,000 - 66,000; Full time

Job summary

Tier4 Group is seeking a Provider Disputes Support Specialist to join a collaborative healthcare operations team in Baton Rouge. You will coordinate provider disputes and appeals, ensuring cases are received, researched, routed, documented, and tracked accurately from start to finish.

You will research claims and authorization details, navigate Facets and Jiva, and route cases to the appropriate teams. Strong organizational skills and attention to detail are essential.

Qualifications

• High School Diploma or equivalent required.
• At least 2 years of medical or health insurance office experience.
• Experience with medical claims processing OR provider/member services.
• Working knowledge of healthcare claims, benefits, or insurance operations.
• Experience with Microsoft Word, Excel, and PowerPoint.
• Strong organizational skills and attention to detail.
• Ability to manage multiple cases, priorities, and deadlines.
• Strong written and verbal communication skills.

Responsibilities

• Receive, review, document, prioritize, and assign incoming provider dispute cases.
• Research disputes and route cases to the appropriate Provider Disputes Specialist or work queue.
• Track cases throughout the dispute process and maintain accurate documentation.
• Research claims, benefits, and authorization information related to disputes.
• Navigate Facets and Jiva to review claims and authorization details.
• Route Medical Appeals, FEP Appeals, correspondence, and internal referrals.
• Follow up with internal departments to ensure timelines are met.
• Prepare documentation and materials for reviews.
• Create and maintain electronic and hard-copy case files.
• Update provider dispute databases, queues, and tracking reports.
• Assist with departmental reporting and ad hoc requests.
• Ensure privacy and confidentiality of member/provider information.

Skills

Medical Claims Processing

Provider/Member Services

Claims & Authorization Research

Jiva

Case Intake & Assignment

Case Tracking

Microsoft Office

Documentation & Records Management

Privacy & Confidentiality

Reporting

Attention to Detail

Problem Solving

Education

High School Diploma or equivalent

Job description

Tier4 Group is seeking a Provider Disputes Support Specialist to join a collaborative healthcare operations team in Baton Rouge. You will coordinate provider disputes and appeals, ensuring cases are received, researched, routed, documented, and tracked accurately from start to finish.

You will research claims and authorization details, navigate Facets and Jiva, and route cases to the appropriate teams. Strong organizational skills and attention to detail are essential.