Job Summary
A ProPeer Independent Dispute Resolution (IDRE) Coordinator is an administrative position within our federal dispute resolution program.
The role of the IDRE is to process the workflow of ERISA payment disputes between payor and provider.
This position requires heavy attention to detail, data entry, and a high level of critical thinking.
The position is electronically task driven within the workflow process and involves no external communication outside of the organization.
Requirements
Essential Job Functions General responsibility for processing administrative components of IDRE workflow process Receives and coordinates dispute referrals through data entry into our portal workflow systemDownloading and processing of clinical and administrative documentation pertaining to the disputeNotating disputes within the portal regarding components of the workflow processVerifying and processing disputes for Conflict of InterestValidating eligibility of the dispute within the federally based ERISA programRequesting fees for the dispute process from the initiating and non-initiating partiesProcessing fees received assigning to clinical dispute reviewerSubmitting final payment determinations to all parties through auto generated emailsMeeting daily production requirements for assigned segment of workflow COI/Eligibility/Request Fees: 65 disputes daily Receiving fees/downloading NOOF/assignment to clinical reviewer: 65 disputes daily Submitting closure letters to all parties based on outcome: 65 disputes daily Conducts research driven projects surrounding cases of issue in coordination with IDRE DirectorUtilizes critical thinking to determine outlier processes in conjunction with the rules of the programEnsures compliance processes and procedures are adhered to for all federal requirementsCommunicates with IDRE Director regarding any disputes outside of standardized processEnsures seamless transition of all incoming disputes into the portal in a time sensitive mannerAbility to work via web-based portal applicationsAbility to be resourceful and proactive in dealing with issues that may arise by working with team and IDRE DirectorSupport others in a team environment
•Assumes other activities and responsibilities from time to time as directed
Knowledge and Abilities Requirements Ability to use Microsoft products (Word, Excel, PowerPoint, Outlook)Basic office equipment experience preferred (copier, fax, shipping and receiving tools)Written and verbal communication skills with a demonstrated ability to deliver excellent customer serviceAbility to multi-task and quickly adapt in a fast-paced environmentStrong organizational skillsAttention to detailProfessional appearanceGeneral Typing Skills at 65wpmData Entry 10 Key Skills at 5,000kph / Data Entry Alpha Numeric Skills at 10,000kphProficiency in EnglishExemplary planning and time management skillsAbility to work in high pressure, deadline driven environmentAbility to multitask and prioritize daily workloadHigh level verbal and written communications skillsCritical Thinking Skills • Demonstrated ability to problem solve complex, multifaceted, situations
•Ability to engage easily in abstract thought
•Strong organizational and task prioritization skills
Education and Experience: High School Diploma or equivalent3-5 years experience in an office based professional setting License and Certification: N/A
Driving Essential: No
Position Demands:
This position requires sitting, bending, stooping for up to 8 hours per day in an office setting.
Ability to lift and move objects weighing up to 20 lbs.
Ability to learn technical material.
The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc.
The person in this position frequently communicates with guests, employees, and vendors and must be able to exchange accurate information.
Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification.
They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel.
All ProPeer employees and temporary team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.
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