1 Provider Disputer Resolution (PDR) Examiner Job in Los Angeles, CA
MEDPOINT MANAGEMENT is Hiring a Provider Disputer Resolution (PDR) Examiner Near Los Angeles, CA
Job Description
Summary:
As a Provider Dispute Resolution Examiner, you will be responsible for handling the provider dispute resolution process, resolving disputes in a timely and fair manner, and maintaining accurate records of disputes and their resolution. You will collaborate with providers, internal teams, and external stakeholders to ensure that disputes are resolved in accordance with industry standards and regulatory requirements.
Duties and Responsibilities:
· Meets production standards of 20-30 Hospital Provider Dispute claims per day and 50-75 IPA Provider Dispute claims as established by claims management.
· Assists in other IPA's when needed.
· Submits automation requests through SharePoint.
· Processes Customer Services Inquiries.
· Assists with training new hires.
· Continue with ongoing training to further Claims Adjudication knowledge
· Performs other tasks as assigned by supervisor/manager.
· Attends training meetings and asks questions.
· Provides auditor with training suggestions/examples.
· Adhere to Claims Department policies and procedures. Keeps updated materials and resources provided for accurate and expedient adjudication.
· Ensure that the Examiner's Checklist is verified and done.
· Provide auditor examples of examiner errors.
Minimum Job Requirements:
· Must have a high school diploma or equivalent.
· Must have knowledge of medical terminology, ICD-9, CPT-4, treatment of diagnoses, and COB.
· Minimum 2 years as Examiner II
Skills and Abilities:
· Must be able to communicate with others clearly, tactfully, and professionally.
· Must have strong computer skills with a broad knowledge of software packages. Must be able to follow directions and perform independently according to departmental standards when no directions are given.
· Must possess effective communication skills. Must be able to willingly accept responsibility and possess the desire to learn new tasks.
· Must have strong organizational and mathematical skills.
Job Summary
Full Time
$51k-64k (estimate)
05/03/2024
05/16/2024
medpointmanagement.com
WOODLAND HILLS, CA
25 - 50
1988
SHELDON LEWENFUFF PREIDENT
$10M - $50M
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About MEDPOINT MANAGEMENT
MedPoint Management provides IPA management, development and consulting services as well as comprehensive claims processing, medical affairs and financial operations. Clients receive the services of a large medical system in a smaller, more personal setting. MedPOINT Management, Inc. (MPM) provides all aspects of managed care management services to Independent Practice Associations (IPAs) and hospital clients. Our customized management approach meets the unique needs of each of our clients which allows us to successfully manage smaller groups comprised of single physician practices along with ...large groups of FQHC clinics and all practice models in between. Our experienced and knowledgeable staff provides a consistently high level of healthcare management services and strategies. Innovation and commitment to high quality, cost-effective care contribute to the overall satisfaction of our clients and members. Founded in 1987, MedPOINT currently represents a client base of over 4,000 contracted providers throughout California. Our managed IPAs are responsible for coordinating care for over 950,000 members in multiple contracted health plans. The contracts represent various payer mixes including Commercial HMO/PPO, Medi-Cal, Covered California (Exchange), Medicare Advantage and Medi-Medi including CalMedi Connect product lines. Understanding the power of information, MPM has made a significant investment in sophisticated IT systems enabling our management, clinical and administrative staff to efficiently work to coordinate high quality, cost effective, integrated care. The ability to readily track and trend utilization and quality metrics has been a vital component in improving overall health management, impacting the delivery of chronic and episodic care, yielding favorable health outcomes, and assisting our provider networks to meet or exceed health plan benchmarks for HEDIS, STARs and P4P programs. MedPOINTs full range of services are consistently delivered with the same high quality standards that has built our reputation. Flexibility, innovation and an openness to change are what the future demands of us as the nation moves into a new era of Health Care reform. The services MPM is delivering today will continue to embrace these notions to add value to our current and future client base.
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