Provider Disputes & Appeals Specialist

LaSalle Medical Associates IPA; California (MO); On-site; USD 60,000 - 80,000; Full time

Job summary

LaSalle Medical Associates IPA is hiring a Provider Dispute Resolution Specialist in California. This role involves the timely review and resolution of provider disputes related to claims adjudication. Candidates should have at least 5 years of experience in managed care health claims and strong skills in medical coding. The position requires proficiency with claim forms and excellent communication skills, supporting compliance with relevant regulations while fostering positive relations with providers.

Qualifications

• 5+ years of experience processing managed care health claims.
• 2+ years in Provider Dispute Resolution or Appeals within Medicare or Medicaid environments.

Responsibilities

• Review and resolve provider disputes related to claims adjudication.
• Ensure compliance with state and federal regulations.
• Support positive provider relations.

Skills

Knowledge of managed care claims operations

Medical coding proficiency

Experience with claim forms (UB-04, CMS-1500)

Data analysis skills

Strong communication skills

Time management skills

Proficiency in Microsoft Office

Problem-solving skills

Education

High school diploma or equivalent

Coursework in healthcare administration or medical billing

Job description

LaSalle Medical Associates IPA is hiring a Provider Dispute Resolution Specialist in California. This role involves the timely review and resolution of provider disputes related to claims adjudication. Candidates should have at least 5 years of experience in managed care health claims and strong skills in medical coding. The position requires proficiency with claim forms and excellent communication skills, supporting compliance with relevant regulations while fostering positive relations with providers.