Temporary Provider Dispute Coordinator II

Location: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California

This is a temporary position and the length of assignment is estimated to go from February 2025 through December 2025 . The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.

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 requirements click 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.
• This is a temporary position and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed).

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).