Dispute Repricing Specialist
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Louisiana • Mississippi • United States
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Salary
💰 $19 - $42 per hour
About the role
- Review provider dispute resolutions according to organizational guidelines.
- Research and respond to provider participation and pricing inquiries, specifically related to network contracts and agreements.
- Research identified issues; submit claim adjustment requests and determine the root cause of disputes.
- Serve as subject matter expertise in evaluating and responding to provider participation and pricing inquiries.
- Analyze post-paid healthcare claims as it relates to pricing needs.
- Apply in-depth research to determine accuracy of PPO(s) use and pricing discounts applied.
- Communicate externally and with internal departments as it relates to various cases under review.
- Coordinate with other departments as necessary to facilitate resolution of claim related participation and pricing issues.
- Reading and interpreting appeals, standard reference materials, etc.
- Perform other duties as assigned.
Requirements
- 2+ years of experience in healthcare, specifically with medical terminology, claim forms, and physician billing coding.
- 1+ years of experience with provider disputes.
- Demonstrated technical proficiency with Microsoft Office applications (Outlook, Excel, Teams, etc.).
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical terminologyclaim formsphysician billing codingprovider disputesclaim adjustment requestspost-paid healthcare claimsPPO pricing discountsresearch analysis
Soft skills
communicationproblem-solvinginterdepartmental coordinationsubject matter expertise