Senior Manager, Provider Disputes Resolution
Alignment Health
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $85,696 - $128,543 per year
Job Level
About the role
- Manages the day-to-day operations ensuring timely and accurate resolution of provider disputes.
- Develops and implements department metrics and performance standards; assists team in meeting or exceeding departmental performance standards.
- Maintains compliance in all areas of operations.
- Monitors staff production and work quality.
- Ensure staff fully understands expectations.
- Conducts quality audits and root-cause analyses to identify opportunities for improvement and implement corrective actions.
- Collaborate effectively with cross-functional teams and develop positive relationships with internal and external stakeholders to ensure timely and accurate resolution of payment disputes.
- Serves as the subject matter expert to assist with regulatory audits, as required, as well as prepare materials required for regulatory audit submission.
- Analyze dispute trends and root causes to identify operational gaps and recommend process improvements.
- Provides guidance and support to team members in resolving complex claim disputes.
- Develops and maintains department’s policies, procedures and workflows which support efficient and compliant provider dispute resolutions.
- Manage and oversee vendor performance, ensure contractual compliance and service level agreement.
- Lead and motivate a high-performance team through effective recruitment, onboarding, training, and retention strategies.
Requirements
- 5+ years management experience in provider dispute and provider post payment resolution in Medicare managed care or health plan setting
- Required: High School Diploma or GED
- Preferred: Bachelor's degree in healthcare management or related field; or equivalent combination of education and experience
- Comprehensive knowledge of Medicare Advantage claims processing requirements, CMS reporting requirements and other related regulatory requirements
- Comprehensive knowledge of Medicare Advantage claims processing requirements and other related regulatory requirements
- Extensive knowledge of different payment methodologies (PPS, Medicare fee schedules, etc.), claims coding and billing requirements
- Proven problem-solving skills and ability to translate knowledge to the department
- Proven leadership abilities with a track record of successfully managing teams, mentoring direct reports, and achieving results.
- Strong organizational and decision-making skills and attention to details
- Ability to work well in a fast-paced and dynamic environment.
- Required: Intermediate to Advance proficiency in MS Office products – Word, Access, and Excel
- Preferred: Hands-on experience working with claims system, Facets claims system a strong plus
Benefits
- Health insurance
- 401(k) retirement plans
- Paid time off
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Medicare Advantage claims processingclaims codingbilling requirementspayment methodologiesPPSregulatory compliancedata analysisroot-cause analysisperformance metricsprocess improvement
Soft Skills
problem-solvingleadershipmentoringorganizational skillsdecision-makingattention to detailcollaborationcommunicationteam motivationtraining
Certifications
High School DiplomaGEDBachelor's degree in healthcare management