What are the responsibilities and job description for the Dispute resolution position at HCSC?
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Job Summary
This position is responsible for intake, processing, coordinating all materials and information relating to processing negotiations and independent disputes as regulated by federal or state regulations.
This applies to all plans at HCSC all lines of business and all products. Additionally, this position will accurately process and respond according to the HCSC procedures via the required notifications and provider resolution.
This includes entry of new requests via the appropriate database.
- Complete, organize and oversee the negotiation and IDR process of assigned cases to ensure all receipts are processed accurately and promptly.
- Complete dispute procedures as assigned such as intake, case creation, package creation, IDR Entity coordination and response, invoice payment coordination or research.
- Monitor timely case completion according to the statute, through claim adjustment and IDR Entity invoice.
- Categorizing and routing Host plan disputes via BlueSquared, route to Network per the Department guideline, and acting as the liaison with other units regarding dispute issues.
- Determine need for obtaining additional information and notifying providers as related to the processing of disputes.
JOB REQUIREMENTS :
- High School Degree or GED.
- Analytical, problem solving and research skills.
- Organizational skills to accommodate large volume of reference materials combined with time management skills.
- Verbal and written communication skills to clearly express oneself; exercises diplomacy.
- Experience working both independently and in a team environment to meet deadlines according to regulations
- 1 year experience in a customer service role OR in a health insurance or medical environment.
- Experience and skills to organize tasks and accommodate large volume of reference materials.
PREFERRED JOB REQUIREMENTS :
- Medical terminology.
- Ability to think clearly and maintain a professional, poised attitude under pressure.
- Detail oriented.
- 2-year experience processing claims and utilizing a claims payment system.
- Knowledge of Senate Bill 1264.
This role is remote / telecommute and you must live within a 250 mile radius of an HCSC location in IL or TX.
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HCSC Employment Statement :
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range $17.20 - $27.15
Last updated : 2024-08-03
Salary : $17 - $27
