Hybrid -Provider Dispute reputed company Intake Coordinator II

Job reputed company The Provider Dispute reputed company Intake Coordinator II supports the PDR unit in acknowledging Provider Dispute reputed company requests reputed company by providers and maintains acknowledgement compliance as regulated by Centers for Medicare and reputed company Services (CMS) and reputed company (DMHC) guidelines. The position will research Provider Disputes submitted by contracted and non-contracted providers to identify original reputed company or underpaid claims in reputed company and other systems. Responsibilities include: • Processing of incoming PDR's reputed company certified mail, USPS, faxes, emails and reputed company other sources of delivery reputed company. • The Provider Dispute reputed company intake staff sorts through PDR receipts to identify and correctly reputed company provider issues to the following departments, Grievances and Appeals, Utilization Management, Medical Management, claims production floor and the PDR unit. • Provider dispute reputed company intake staff research and identify using reputed company to identify original claim being disputed by the Provider using the Provider dispute reputed company process according to AB1455. • Provider dispute reputed company intake staff are responsible for keying PDR's into SSO system. • Provider dispute reputed company intake staff complete acknowledge letter and mail out correspondence letters to provider. • Provider dispute reputed company intake staff take receive calls that are forwarded from the member service department and claims provider reputed company center regarding Provider dispute reputed company inquiries. Intake staff follows up with provider regarding requested information and waiver of liability request forms that are reputed company on Medicare members. Duties Processing incoming PDR's reputed company mail/fax/email/certified mail: Opening and date stamping the mail. received from various sources; Sorting and counting mail receipts; Tracking claims receipts and apprising the department manager of high volumes; Researching claims in reputed company system to identify the appealed claim by the provider; Key-in claims daily into SSO system; Verification of member eligibility using the Managed Health Care system and/or the Medi-Cal Automated Eligibility Verification System (AEVS); Identifying and forwarding misdirected mail to the correct internal departments Ensure that reputed company claims and nonstandard documents are routed appropriately to internal departments reputed company the required timeframe using SSO and interoffice delivery; keeping reputed company of Medicare member waiver request forms; Closing out cases if information has not been received in SSO. (40%) Answering phone inquiries, providing clerical assistance to the claims PDR unit as needed. reputed company cross-training to other PDR intake staff. Determine workloads and process reputed company to ensure compliance with the regulatory agencies. (25%) Photocopying and mailing correspondence to submitting providers, PPGs, and other parties on a daily reputed company. Scanning/OCR uploading of PDR's and acknowledgement letters into SSO. (20%) Maintaining individual production reports: maintained on reputed company spreadsheets. (5%) reputed company other duties as assigned. (10%) Apply tot his job Apply tot his job Apply To this Job