Disputes Resolution Specialist
Company: Prime Health Services, Inc.
Posted on: January 9, 2022
The Disputes Resolution Specialist acts as a liaison between the
provider, the client, and affiliate network partners to quickly and
accurately resolve claim repricing disputes. This position
researches provider participation and determines the correct
repricing of disputed claims while maintaining pre-existing
relationships between Prime Health, clients, and providers.
The Disputes Resolution Specialist will serve as the first level
liaison between the provider and Prime Health Services clients to
resolve PPO disputes.
Essential Job Functions
Reviews all available claim dispute information including EOB,
claim form, and provider appeals.
Researches Prime Health Services/provider contract and other
documents to determine an accurate resolution.
Communicates resolution with clients, providers, and affiliate
networks in a professional and timely manner.
Logs claim disputes accurately based on the submitted EOB and claim
Answers provider inquiries over the phone and via email.
Meets monthly dispute resolution goals as determined by the Manager
of Disputes Resolution.
Discusses difficult resolutions in a calm and professional
Maintains integrity by determining the most accurate resolution for
Works with other Disputes Resolution Specialists and Manager of
Disputes Resolution on special projects when necessary.
Handles Workers Compensation, Group Health, and/or Auto PPO
Follows the department training guide to ensure correct steps are
followed to complete the resolution process.
High school diploma or GED
Proficient in Microsoft Office Suite, including Office, Excel, and
Friendly, professional demeanor
Excellent written and oral communication skills
Excellent investigative and problem-solving abilities
Exceptional organization and time management skills - ability to
handle a high volume of accounts
Ability to work effectively and collaboratively in a team
Strong attention to detail and accuracy
Ability to handle stressful situations with a calm demeanor.
Experience working in a deadline driven environment.
Who We Are
Prime Health Services is a national medical cost containment
company offering a PPO network to the workers' compensation, group
health, corrections, and auto liability markets. Our preferred
provider network has been expanding since 2001 and now has over
800,000 medical providers and health care facilities nationwide
with over 900,000 locations. The Prime Health Services PPO Network
is available to insurance carriers, third-party administrators
(TPAs), self-insured employers, governmental entities,
corporations, and associations.
We look for candidates who build a culture of teamwork and positive
results. To be successful at Prime, you need to be
forward-thinking, have an innovative spirit, be empowered to do
your job well, act collaboratively, and be reliable. We're a
company on the move and strive for excellence in everything we
If this sounds like you, please submit your application today or
pass this along to anyone who is searching for their next role with
a growing company.PI160173149
Keywords: Prime Health Services, Inc., Franklin , Disputes Resolution Specialist, Other , Franklin, Tennessee
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