Dispute Resolution Analyst For Provider Claims

Description:

We are seeking a Provider Dispute Resolution Analyst to play a key role in addressing provider disputes related to Fee Negotiation, Network, Multi-Service, and Bill Review & Audit claims. This position is essential for maintaining the integrity of our service and ensuring optimal client satisfaction through effective dispute resolution. The ideal candidate will exhibit strong customer service capabilities, including exceptional verbal and written communication skills. Your contributions will be measured through key performance indicators such as the average time taken to resolve disputes, savings retention, and the accuracy of documentation.

Key Responsibilities
 

• Conduct thorough research and resolve provider and client billing inquiries, including renegotiating claims as needed to achieve cost savings.
• Maintain meticulous tracking of all relevant information related to the resolution of assigned disputes.
• Collaborate closely with internal teams, such as Client Services, Network Management, and Bill Review & Audit, to ensure efficient resolution of issues.
• Assist team members in navigating complex claims or escalated provider concerns.
• Directly communicate with clients to provide updates and inform them of resolved issues.
• Uphold compliance with HIPAA regulations and Zelis standards concerning privacy.
• Support the Customer Care Team as needed to ensure seamless service delivery.
• Undertake additional responsibilities as required to meet organizational goals.
   

Required Skills
 

• Strong verbal and written communication skills.
• Excellent problem-solving capabilities.
• Ability to work collaboratively with internal teams.
• Familiarity with HIPAA regulations and privacy standards.
• Proficient in time management and tracking of essential information.
   

Qualifications
 

• Prior experience in customer service or dispute resolution is preferred.
• A solid understanding of billing processes and medical claims.
• Proven ability to effectively communicate with both clients and providers.
• Experience in a collaborative team environment.