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AmeriHealth Caritas · 22 hours ago

Coordinator Provider Disputes

United States

Full-time

Remote

Entry Level

1+ years exp

AmeriHealth Caritas is a mission-driven organization focused on delivering comprehensive care solutions. The Coordinator Provider Disputes is responsible for managing provider disputes, analyzing claims, and ensuring timely resolutions while maintaining accurate records and communication with stakeholders.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

Performs administrative tasks, included but not limited to, Fax Management (storage and distribution), letter processing and storage, data collection and assembling/filing completed disputes within provider disputes platform

Manages, adjudicates, and determines ownership of provider disputes submitted from providers, account executives and PCSU. Investigates findings of claim denials and reports underlying reasons for identified data quality issues to management

Participates in quarterly meeting with governing body and reports comprehensive list of data quality issues present during a given period

Communicates with providers to resolve problems with provider dispute requests that are not submitted according to Plan’s policy

Maintains an accurate, timely and complete record of provider disputes in a system that tracks the stages of the dispute, how long it takes to resolve the disputes, and manages distribution of the provider disputes to the appropriate stakeholders

Adheres to timely resolution of dispute process as established in current Plan’s policy

Collects, analyzes and reviews historical provider dispute information to incorporate into departmental provider dispute documentation

Ensures compliance with record retention plan according to Plan’s policy

Coordinates the presentation of the provider disputes to a Provider Disputes Team Lead, Supervisor or manager and participates as a member for a 2nd review

Communicates decisions (either verbally or in writing) made by the Provider Dispute team to providers within Plan timeframe, when necessary

Identifies and reports on provider issues appropriate for use as educational opportunities to the Provider Services management staff

Other duties as assigned by management

Qualification

Medical office billingClaims administrationHealth services administrationMS WordMS ExcelMS PowerPointAnalytical skillsCommunication skillsTeam collaboration

Required

High School Diploma/GED required

Proficiency in MS Word, Excel & PowerPoint

Preferred

Associate Degree with an emphasis in health services administration or equivalent experience and education preferred

Medical office admin and/or claims admin, especially Medicaid billing preferred

1 to 3 years medical office billing experience

Benefits

Flexible work solutions including remote options

Hybrid work schedules

Competitive pay

Paid time off including holidays and volunteer events

Health insurance coverage for you and your dependents on Day 1

401(k)

Tuition reimbursement

And more.

Company

AmeriHealth Caritas

Glassdoor3.4

AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.

Founded in 1982

Philadelphia, Pennsylvania, USA

10001+ employees

http://www.amerihealthcaritas.com

H1B Sponsorship

AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (18)

2024 (17)

2023 (12)

2022 (14)

2021 (4)

2020 (11)