Provider Dispute Resolution Specialist - Hybrid - 141256

Minimum Qualifications: Six (6) years of related experience, education/training, OR a Bachelor's degree in related area plus two (2) years of related experience/training. Related experience: processing professional and facility claims within Epic Tapestry. Working knowledge of common organization- or research-specific and other computer application programs. Proficient in communication and interpersonal skills to communicate effectively, both verbally and in writing. Proficient in ability to use discretion and maintain all confidentiality. Demonstrates ability to use sound judgment in responding to issues and concerns Demonstrates ability to analyze, research and synthesize large amounts of data with strong attention to detail. Proficient in ability to multi-task with demanding timeframes. Working knowledge of applicable policy analysis techniques.

Preferred Qualifications: Experience reviewing, approving and denying claim appeals in Epic Tapestry. Experience interpreting Division of Financial Responsibility (DOFR) agreements and delegated claims payment responsibilities. Knowledge of California provider dispute resolution requirements and managed care regulatory standards. Special Conditions: Must be able to work various hours and locations based on business needs. Employment is subject to a criminal background check and pre-employment physical.