Company Description

ClientSolv Technologies is an IT solution firm with over a decade of experience serving Fortune 1000 companies, public sector and small to medium sized companies. ClientSolv Technologies is a woman-owned and operated company that is certified as a WMBE, 8a firm by the Federal government's Small Business Administration.

Job Description

We are seeking a Provider Dispute Resolution Intake Coordinator for a contract, with the option to extend or hire, role in Los Angeles, CA.  This role will onsite/ in the office (possibility for hybrid schedule).  

In this role, you will support the Provider Dispute Request unit in acknowledging Provider Dispute Resolution requests sent by providers and maintain acknowledgement compliance as regulated by Centers for Medicare and Medicaid Services (CMS) and California Department of Managed Health Care (DMHC) guidelines. The position will research Provider Disputes submitted by contracted and non-contracted providers to identify original paid or underpaid claims in MHC and other systems.  

Duties

• Processing incoming Provider Dispute Requests via 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 Managed Healthcare 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 paper claims and nonstandard documents are routed appropriately to internal departments within the required timeframe using SSO and interoffice delivery
• Keeping track of Medicare member waiver request forms
• Closing out cases if information has not been received in SSO.
• Answering phone inquiries, providing clerical assistance to the claims PDR unit as needed. 
• Photocopying and mailing correspondence to submitting providers, PPGs, and other parties on a daily basis.
• Scanning/OCR uploading of PDR's and acknowledgement letters into SSO. 
• Maintaining individual production reports: maintained on EXCEL spreadsheets. 

Qualifications

Education Required

High School Diploma/or High School Equivalency Certificate

Experience Required:
At least 0-6 months experience in a claims data entry and clerical position preferred in healthcare environment.

Skills Required:

• Proficient with Microsoft Office (Word, Excel).
• Strong data entry and filing skills.
• Professional telephone manner.
• Excellent communication skills.
• Strong customer service orientation to both internal and external customers. 
• Must be dependable and able to prioritize and accomplish work with minimal supervision.

Must know Centers for Medicare and Medicaid Services(CMS) and Department of Managed Health Care (DMHC) timeliness requirement that pertain to AB1455 PDR Acknowledgment and resolution section.

Additional Information

This contract, with the option to hire, role will be located in Los Angeles, CA.  This role will onsite/ in the office (possibility for hybrid schedule). Candidates who reside in or can make the commute to Los Angeles, CA are encouraged to apply.  This role will pay between $22– $23 per hour (W2) during the contract period.