Temporary Provider Dispute Coordinator II

Central California Alliance for Health; California (MO); Remote; USD 60,000 - 80,000; Full time

Job summary

Central California Alliance for Health is seeking a Temporary Provider Dispute Coordinator II for a remote position managing provider disputes in their Claims Quality Department. Ideal candidates will have knowledge in healthcare billing processes and a high school diploma with relevant experience. This temporary role allows you to impact local healthcare services within a dynamic, diverse team environment.

Benefits

Medical, Dental, and Vision Plans

Ample Paid Time Off

12 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Health and Wellness Program

Onsite EV Charging Stations

Qualifications

• Two years experience with provider disputes or member appeals.
• Familiarity with Medi-Cal and CMS claims guidelines.
• Competent in auditing data and making recommendations.

Responsibilities

• Coordinate and respond to provider dispute inquiries.
• Assist with low to moderate complexity Provider Dispute cases.
• Perform administrative duties supporting Claims Quality.

Skills

Knowledge of healthcare coverage

Customer service principles

Research and analysis methods

Education

High school diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Temporary Provider Dispute Coordinator II

ABOUT THESE TEMP POSITIONS

These are temporary positions and the length of assignments are estimated to go for 3-6 months. The length of the assignments are always dependent on business need and dates may change. While the assignments would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. These are fully remote roles and must be based in California.

We have 2 opportunities to join the Alliance as a Temporary Provider Dispute Coordinator II in the Claims Quality Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Claims Quality Supervisor, this position:

• Coordinates and responds to moderate complexity level one inquiries in the Provider Dispute process
• Assists with the coordination and completion of low to moderate complexity level two Provider Dispute cases
• Performs administrative duties in support of the Claims Quality unit and related functions

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirementsclick here .

• Knowledge of:
  • Healthcare coverage and benefit structures, principles of coordination on benefits and medical billing
  • Principles and practices of customer service
  • The methods and techniques of research, analysis and reporting
  • Windows based PC systems and Microsoft Word, Excel, and Outlook, and database software
• Ability to:
  • Audit information and data, identify anomalies and make recommendations for correction
  • Apply relevant Medi-Cal, Department of Health Care Services, and Centers for Medicare & Medicaid Services claims processing guidelines and regulations
  • Utilize conflict resolution and problem solving techniques
  • Understand and interpret policies, procedures, and regulations
  • Understand and analyze contractual and regulatory requirements and their application to the resolution of disputes
• Education and Experience:
  • High school diploma or equivalent
  • Two years of experience administering provider disputes or member appeals and grievances or administering provider claims in a managed care setting, health plan, or provider office (an Associate’s degree or Medical Assistant Certification issued by a certifying organization approved by the Medical Board of California may substitute for one year of the required experience); or an equivalent combination of training and experience may be qualifying

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

$27.21 - $35.37 USD

Merced County Pay Range

$24.76 - $32.19 USD

Monterey County Pay Range

$27.21 - $35.37 USD

Mariposa County Pay Range

$24.76 - $32.19 USD

San Benito County Pay Range

$24.76 - $32.19 USD

OUR BENEFITS

Available for all regular Alliance employees working more than 30 hours per week.Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at ourFact Sheet .

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

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