Top 166 Provider dispute resolution Jobs in California

PROVIDER DISPUTE RESOLUTION SPECIALIST
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $42.79 - $48.75 an hour
- Full-time
- 5 years
- HIPAA
- Research
- Health insurance
- Dental insurance
Provider Dispute Resolution Specialist
LSMA Management Inc —San Bernardino, CA
- $33.50 - $39.50 an hour
- Full-time
- 5 years
- Writing skills
- English
Associate General Counsel, Distinguished - Dispute Resolution
Blue Shield of California —Oakland, CA
- $219,340 - $318,890 a year
- Full-time
- Hybrid work
- Background check
- Pass drug screening
- 8 years
- Work from home
Program Specialist - Special Education
Aspire Public Schools —Oakland, CA
- $115,148 - $147,818 a year
- Full-time
- Spanish
- Experience working with individuals with disabilities
- 5 years
- Disability insurance
- Health insurance
Chief Medical Officer
Altais Health Solutions —Oakland, CA
- $294,525 - $385,560 a year
- Full-time
- Background check
- Medicine
- 6 years
- Paid holidays
- Health insurance
Quick Apply
Social Worker - Bilingual Chinese or Spanish
Tenants and Owners Development Corporation (TODCO) —San Francisco, CA
- $35.48 - $43.37 an hour
- Full-time
- Bilingual
- Background check
- Spanish
- Health insurance
- Dental insurance
Quick Apply
Senior Litigation Attorney - Personal Injury
DC Law Group, PC —Beverly Hills, CA
- $140,000 - $500,000 a year
- Full-time
- Writing skills
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Quick Apply
In-House Corporate Counsel
Confidential —Irvine, CA
- $150,000 - $175,000 a year
- Full-time
- Office
- In-person
- Senior level
- Health insurance
- Dental insurance
Quick Apply
12d
Employment Litigation Associate Attorney
Orion Placement —Newport Beach, CA
- $165,000 - $225,000 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- Writing skills
- Health insurance
- Dental insurance
Quick Apply
Employment Litigation Associate Attorney
Orion Placement —Anaheim, CA
- $165,000 - $225,000 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- Writing skills
- Health insurance
- Dental insurance
Quick Apply
Shop Foreman
Harrington Industrial Plastics —Baldwin Park, CA
- $100,000 - $120,000 a year
- Full-time
- 7 years
- Microsoft Excel
- Adults
- Paid jury duty
- Health savings account
Quick Apply
Contracts and Litigation Paralegal
Pacific Maritime Group Inc DBA Pacific Tugboat Service Inc —San Diego, CA
- $40 - $50 an hour
- Full-time
- Microsoft Excel
- Customer service
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
8d
Workers’ Compensation Manager (Human Resources Manager)
AC Transit —Oakland, CA
- $156,059 - $186,365 a year
- Online Application
- Customer service
- Office
- 3 years
- Wellness program
- Commuter assistance
Claims Management Manager
Speed Express —Montebello, CA
- $80,000 - $110,000 a year
- Full-time
- Background check
- English
- Office
- Health savings account
- Health insurance
Quick Apply
Litigation Attorney - Personal Injury
DC Law Group, PC —Beverly Hills, CA
- $140,000 - $350,000 a year
- Full-time
- Writing skills
- Mid-level
- In-person
- Health insurance
- Dental insurance
Quick Apply
Regional Salon Manager
Phenix Salon Suites —Los Angeles, CA
- From $65,000 a year
- Weekends as needed
- Up to 50% travel
- Customer service
- Mid-level
- Paid time off
Quick Apply
Operations Manager
Harrington Industrial Plastics —Baldwin Park, CA
- $115,000 - $130,000 a year
- Full-time
- Microsoft Word
- Microsoft Excel
- Sales
- Paid jury duty
- Health savings account
Quick Apply
Revenue Cycle Specialist
Acacia Health —Irvine, CA
- $72,000 - $75,000 a year
- Full-time
- Research
- Mid-level
- Office
- Health insurance
- Dental insurance
Quick Apply
Administrative Director – Student Support Services (Assistant Principal/Special Education)
El Camino Real Charter High School —Woodland Hills, CA
- $142,623 - $177,909 a year
- Full-time
- School experience
- High school
- Experience working with individuals with disabilities
- Paid holidays
- Health insurance
Quick Apply
Social Worker/Case Manager
Tenants and Owners Development Corporation (TODCO) —San Francisco, CA
- $35.48 - $43.37 an hour
- Full-time
- Background check
- Spanish
- Master of Social Work
- Health insurance
- Dental insurance
Quick Apply

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provider dispute resolution jobs near california

PROVIDER DISPUTE RESOLUTION SPECIALIST

NORTH EAST MEDICAL SERVICES -
Burlingame, CA

Apply Now

Job Details

Full-time
$42.79 - $48.75 an hour

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance

Qualifications

Research

Full Job Description

The MSO department seeks a PDR Specialist with strong verbal and written communication skills to handle provider disputes and appeals related to claims payments. This role involves researching, evaluating, and resolving claims disputes in line with regulations, policies, and industry standards. The specialist will also conduct root cause analyses, process claims readjustments, support system improvements, and manage the overpayment recoupment process.

The role requires an individual with strong analytic skills and critical thinking/problem solving skills. This individual must also have exceptional interpersonal skills to build and maintain positive working relationships.

Key Responsibilities:

Review and resolve provider payment disputes and appeals for Medi-Cal Managed Care, Medicare Advantage, and PACE programs.
Respond to complex provider inquiries regarding claims adjudication and payments.
Ensure timely and accurate resolutions to disputes per regulatory guidelines.
Maintain accurate records of dispute resolutions and update tracking systems.
Identify and correct claims payment errors, process adjustments, and handle provider overpayment refunds.
Analyze payment trends and escalate training or process improvement needs.
Assist with health plan audits and other projects related to provider dispute process as required.
Identify system configuration issues and report for resolution.
Performs other job duties as required by manager/supervisor and NEMS Management Team.

Bachelor’s degree preferred. Associate degree with relevant experience may be considered.
Minimum five years of experience in medical claims adjudication required.
Strong analytical, problem-solving, and communication (written & verbal) skills.
Knowledge of Medi-Cal & Medicare Advantage claims reimbursement and dispute resolution.
Familiarity with healthcare compliance (HIPAA, CMS, DHCS, AB1455).
Understanding of medical terminology, coding, and claim forms.
Detail-oriented with strong organizational and time management skills.
Proficiency in PC-based software and database management.

LANGUAGE:

Must be able to fluently speak, read and write English.
Fluent in other languages are an asset.

STATUS:

This is an FLSA Non-Exempt position.
This is not an OSHA high-risk position.
This is a full-time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

Apply Now

Refine Your Search

provider dispute resolution jobs in california

PROVIDER DISPUTE RESOLUTION SPECIALIST

Provider Dispute Resolution Specialist

Associate General Counsel, Distinguished - Dispute Resolution

Program Specialist - Special Education

Chief Medical Officer

Social Worker - Bilingual Chinese or Spanish

Senior Litigation Attorney - Personal Injury

In-House Corporate Counsel

Employment Litigation Associate Attorney

Employment Litigation Associate Attorney

Shop Foreman

Contracts and Litigation Paralegal

Workers’ Compensation Manager (Human Resources Manager)

Claims Management Manager

Litigation Attorney - Personal Injury

Regional Salon Manager

Operations Manager

Revenue Cycle Specialist

Administrative Director – Student Support Services (Assistant Principal/Special Education)

Social Worker/Case Manager

I want to receive the latest job alert for provider dispute resolution in california

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