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Salary: USD 70,304 - 81,395.73 / annual
WelbeHealth is seeking a Dispute Specialist to oversee and resolve first-level disputes between the organization and contracted and non-contracted providers regarding claim payments, claim denials, and contractual agreements. This role is critical to ensuring compliance in all claims-related processes, identifying trends, educating providers on proper processing, and promoting provider satisfaction.
Key responsibilities include:
- Examining claim records and forms to investigate and resolve first-level disputes while meeting established quality and production standards
- Processing acknowledgment and determination letters and providing detailed notes on dispute decisions and reasoning
- Creating correspondence for the Senior Examiner and collaborating with leadership on improper processing trends and claim-related concerns
- Establishing and maintaining effective working relationships with team members, interdepartmental staff, and leadership
- Maintaining comprehensive knowledge of claim processing guidelines, procedures, governing regulations, and compliance requirements
- Assisting with data entry of incoming clean claims as needed
WelbeHealth serves vulnerable seniors through shared intention, pioneering spirit, and a commitment to participant-focused care. The organization emphasizes work-life balance, advancement opportunities, and a supportive culture.
Qualifications and Requirements:
- High school diploma or equivalency (professional experience may be substituted)
- Experience in a Managed Care Plan (MCP) or PACE organization (PO) claims processing environment
- Minimum of 3 years of health plan claims processing experience and 2 years of health plan claims dispute experience analyzing and resolving provider claims
- Strong computer and software knowledge including Excel, Outlook, PowerPoint, Word, Teams, and job-specific applications/systems
- Ability to navigate state/federal websites and medical billing guidelines using online resources to resolve outstanding claims and disputes
- Excellent verbal and written communication skills, organizational and time management skills, and problem-solving and decision-making abilities
