Senior Manager, Provider Appeals & Disputes

L.A. Care; Los Angeles (CA); Vor Ort; USD 135.000 - 216.000; Vollzeit

Benefits dieser Stelle

Paid Time Off

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Zusammenfassung

L.A. Care Health Plan in Los Angeles, CA is seeking a Senior Manager for Provider Appeals and Dispute Resolution Management to oversee the full lifecycle of provider appeals, payment disputes, and complex reimbursement issues.

You will establish standardized processes for intake, investigation, resolution, and closure while ensuring regulatory compliance. The role emphasizes reducing administrative friction, improving provider satisfaction, and leading a high-performing team.

Qualifikationen

• Bachelor's degree in a related field required.
• Extensive experience managing provider appeals, payment disputes and claim escalations.
• Strong contract interpretation and regulatory compliance expertise.

Aufgaben

• Oversee end-to-end management of provider appeals, payment disputes, claim escalations and complex reimbursement concerns.
• Develop standardized dispute resolution processes for intake, triage, investigation, assignment, resolution and closure.
• Lead cross-functional reviews to ensure contract language aligns with claims configuration and reimbursement methodologies.
• Direct budgeting, staffing, coaching and development of the department to meet performance goals.
• Prepare executive summaries for senior leadership on significant disputes and settlements.

Kenntnisse

Provider dispute resolution

Contract interpretation

Regulatory compliance

Root-cause analysis

Cross-functional leadership

Budgeting

Ausbildung

Bachelor's Degree

Master's Degree (Preferred)

Jobbeschreibung

L.A. Care Health Plan in Los Angeles, CA is seeking a Senior Manager for Provider Appeals and Dispute Resolution Management to oversee the full lifecycle of provider appeals, payment disputes, and complex reimbursement issues.

You will establish standardized processes for intake, investigation, resolution, and closure while ensuring regulatory compliance. The role emphasizes reducing administrative friction, improving provider satisfaction, and leading a high-performing team.