Job Application for Provider Dispute Coordinator II at Central California Alliance for Health

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We have an opportunity to join the Alliance as a Provider Dispute Coordinator II in the Claims Quality Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Claims Quality Supervisor, this position:

Coordinates and responds to moderate complexity level one inquiries in the Provider Dispute process
Assists with the coordination and completion of low to moderate complexity level two Provider Dispute cases
Performs administrative duties in support of the Claims Quality unit and related functions

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

Knowledge of:
- Healthcare coverage and benefit structures, principles of coordination on benefits and medical billing
- Principles and practices of customer service
- The methods and techniques of research, analysis and reporting
- Windows based PC systems and Microsoft Word, Excel, and Outlook, and database software
Ability to:
- Audit information and data, identify anomalies and make recommendations for correction
- Apply relevant Medi-Cal, Department of Health Care Services, and Centers for Medicare & Medicaid Services claims processing guidelines and regulations
- Utilize conflict resolution and problem solving techniques
- Understand and interpret policies, procedures, and regulations
- Understand and analyze contractual and regulatory requirements and their application to the resolution of disputes
Education and Experience:
- High school diploma or equivalent
- Two years of experience administering provider disputes or member appeals and grievances or administering provider claims in a managed care setting, health plan, or provider office (an Associate’s degree or Medical Assistant Certification issued by a certifying organization approved by the Medical Board of California may substitute for one year of the required experience); or an equivalent combination of training and experience may be qualifying

OTHER INFORMATION

We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Zone 1 (Monterey, San Benito and Santa Cruz)

$25.60 - $40.97 USD

Zone 2 (Mariposa and Merced)

$23.30 - $37.28 USD

OUR BENEFITS

Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

Medical, Dental and Vision Plans
Ample Paid Time Off
12 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
Onsite EV Charging Stations

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

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Are you a current or former employee of any of the following state agencies? Department of Health Care Services (DHCS), California Department of Social Services (DSS), or Department of Managed Health Care (DMHC)? If yes, please select below. *

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Yes - California Department of Social Services (DSS)

Yes - Department of Managed Health Care (DMHC)

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In addition to hiring regular positions, like the one that you are applying to, we also have temporary positions available at times. Let us know if you would like to be contacted about these opportunities in the future by selecting 'yes' below.

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As a reminder, please use the Employee Careers Portal to login and submit your application. You can access the link through the Weekly TA Announcement.

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The Alliance defines “relatives” to include: spouse / domestic partner, children, siblings, parents, in-laws, step-relatives, nieces, nephews and cousins. This policy also may apply to individuals who are not legally related but who reside with another employee.

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I hereby certify that the facts and information set forth in my application and resume are true and complete. I authorize Central California Alliance for Health and its agents to investigate any and all of the statements that I have made. I understand that if I supply false or misleading information on my application or resume I may not be considered for employment. I also understand that if I become employed, false statements on this application or resume, or omissions of information may result in my termination.

My typed name shall have the same force and effect as my written signature.

U.S. Standard Demographic Questions

The Alliance is dedicated to creating a work environment focusing on inclusivity and belonging, In addition, we are interested in ensuring we have a diverse workforce. To that end, we invite you to voluntarily self-identify your race and ethnicity, as well as provide information on additional demographics. This data will remain anonymous and reported in aggregate to support our Diversity, Equity, Inclusion and Belonging efforts and to improve our future outreach and recruitment efforts.

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Provider Dispute Coordinator II

WHAT YOU'LL BE RESPONSIBLE FOR

OUR BENEFITS

ABOUT US

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U.S. Standard Demographic Questions