PDR INTAKE COORDINATOR NEEDED ASAP!

Location: Los Angeles
Posted on: October 26, 2024

Job Description:

Well known Health Care Company is looking for a Provider Dispute Resolution (PDR) Intake Coordinator. In this role, you will support the PDR unit in acknowledging Provider Dispute Resolution requests sent by providers and maintains compliance as regulated by CMS and DMHC guidelines. Coordinator will research Provider Disputes submitted by contracted and non-contracted providers to identify original paid or underpaid claims in MHC and other systems. Responsibilities include (not limited to):

Processing of incoming PDR?s via certified mail, USPS, faxes, emails and all other sources of delivery methods. You will sort through PDR receipts to identify and correctly route provider issues to the appropriate departments. You will research and identify using MHC to identify original claim being disputed by the Provider using the Provider dispute resolution process. Also responsible for keying PDR?s into SSO system. You will mail out correspondence letters to provider. You will take calls that are forwarded from the member service department and claims provider call center regarding Provider dispute resolution inquiries. You will follow up with provider regarding requested information and waiver of liability request forms that are sent on Medicare members. Email resume as a word attachment to Paris Goldfarb. We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

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