Job Description

Location: Health Choice Management Co.
Posted Date: 10/23/2020

Position Purpose: The Disputes/Appeals Lead upholds and administers claims dispute/appeals processing, and works to meet all regulatory and organizational timelines.

Responsibilities:

  • Reviews and determine workflow for all dispute/appeals submitted by providers
  • Tracks and maintains timeframes for all disputes/appeals processing
  • Ensures appropriate work distribution for disputes/appeals processing
  • Assists in overseeing daily processing activities to ensure regulatory claims compliance
  • Identifies root cause resolution opportunities as appropriate
  • Assists with health plan and regulatory audit reviews
  • Reviews claim adjudication logic for appropriateness
  • Ensures policies and procedures are relevant and updated
  • Works with Documentation/Training staff to ensure appropriate new and on-going training
  • Develop and maintain working relationship with other Departmental Leads
  • Assists in holding regular meetings and in-services with staff
  • Works with IS and System Configuration staff in order to ensure appropriate system modifications and setup, inclusive of updated regulatory fee schedules

Education / Experience / Other Requirements

Education:

  • High school or GED
  • College preferred

Years of Experience:

  • 3+ years in claims processing, inclusive of UB and HCFA 1500s

Specialized Knowledge:

  • ICD10/HCPC/CPT/ADA
  • Claims processing, inclusive of 1500 and UB
  • Medical terminology
  • Computer, inclusive of Microsoft Office and proprietary claims systems
  • Effective communication, verbal and written
  • Medicaid, Medicare, AHCCCS policies and procedures

Skills and Abilities:

  • Ability to lead a team
  • Ability to think analytically and make independent decisions
  • Ability to manage large workload
  • Ability to maintain positive work relationships
  • Handle multiple and changing priorities at a fast pace
  • Work cooperatively, positively, and collaboratively in an interdisciplinary team
  • Effective time management and organizational skills
  • Effective interpersonal and communication skills

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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