Job Description
Job Description
Provider Disputes Support Specialist
Support Critical Provider Relations and Dispute Resolution Operations
We are seeking a detail-oriented and organized Provider Disputes Support Specialist to support the intake, tracking, assignment, and administration of provider dispute cases within a healthcare payer environment. This role serves as a key liaison between internal departments and external stakeholders, ensuring provider disputes, appeals, and correspondence are accurately documented, routed, and resolved within established timelines.
The ideal candidate will have experience in healthcare claims, provider services, medical office operations, or insurance administration and possess strong organizational, communication, and problem-solving skills.
What You'll Do
- Review incoming provider disputes and related correspondence to ensure proper intake and case creation.
- Create, assign, and track dispute cases within enterprise systems and workflows.
- Coordinate the distribution of provider disputes, appeals, and supporting documentation to appropriate teams for review and resolution.
- Prioritize and manage incoming case materials, ensuring timely processing and compliance with service-level requirements.
- Maintain accurate case records, electronic files, and documentation throughout the dispute resolution lifecycle.
- Assist leadership with administrative support, reporting, case tracking, and departmental documentation.
- Support preparation of appeal review materials, case binders, correspondence, and other review documentation.
- Monitor dispute activity and assist with generating reports for leadership, internal committees, and operational reviews.
- Collaborate with internal departments to ensure claims processing and benefit determinations are completed accurately and within required timeframes.
- Ensure compliance with HIPAA, privacy requirements, regulatory standards, and internal policies.
Key Responsibilities
Provider Dispute Intake & Coordination
- Review, research, and assign incoming provider disputes to appropriate team members for investigation and resolution.
- Route appeals, medical reviews, and correspondence to the appropriate departments in a timely manner.
- Track dispute cases from intake through resolution and maintain accurate status updates.
Administrative & Operational Support
- Provide administrative support to department leadership related to case management and reporting.
- Create and maintain electronic and hard-copy files.
- Assist with maintaining departmental databases and tracking systems.
- Support audit requests, reporting requirements, and special projects as needed.
Communication & Collaboration
- Coordinate with internal departments including Claims, Provider Services, Member Services, Legal, Utilization Management, and Correspondence teams.
- Communicate with providers, hospitals, physician offices, and other stakeholders regarding dispute-related documentation and processes.
- Ensure timely follow-up on outstanding cases and requests.
Systems & Documentation
- Navigate healthcare claims and authorization systems to review provider disputes and related case information.
- Research claims and authorization records to support dispute processing activities.
- Maintain accurate records and documentation to support compliance and operational effectiveness.
Qualifications
Education
- High School Diploma or equivalent required.
Experience
- Minimum of two (2) years of experience in a healthcare, medical office, insurance, claims processing, or provider/member services environment.
- Experience supporting healthcare claims operations, provider services, or dispute resolution activities preferred.
- Experience using Microsoft Office applications, including Word, Excel, and PowerPoint.
- Experience with healthcare claims systems and workflow management tools preferred.
Skills & Competencies
- Strong organizational and time-management skills.
- Excellent attention to detail and accuracy.
- Ability to manage multiple priorities in a fast-paced environment.
- Strong written and verbal communication skills.
- Ability to work independently while collaborating effectively across departments.
- Working knowledge of healthcare claims, provider operations, or i