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Provider Dispute Resolution Specialist Jobs (NOW HIRING)

Equity Bank

Dispute Resolution Specialist

Wichita, KS · On-site

Dispute Resolution Specialist Department: Customer Care Center Location: Wichita, Kansas (on-site ... Work jointly with other departments to provide an enhanced customer experience. * Dispute ...

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Provider Dispute Resolution Specialist information

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$34K

$70.3K

$114.5K

How much do provider dispute resolution specialist jobs pay per year?

As of Sep 10, 2026, the average yearly pay for provider dispute resolution specialist in the United States is $70,345.00, according to ZipRecruiter salary data. Most workers in this role earn between $50,000.00 and $86,500.00 per year, depending on experience, location, and employer.

What does a provider dispute resolution specialist do?

A Provider Dispute Resolution Specialist is responsible for handling and resolving disputes between healthcare providers and health insurance companies. Their primary duties include reviewing claims denials or payment issues, investigating the underlying causes, and facilitating communication between providers and payers to reach a fair resolution. They ensure that all disputes are processed in compliance with regulatory requirements and organizational policies. This role is crucial in maintaining positive relationships between providers and insurers while ensuring timely and accurate payment of healthcare services.

What are the key skills and qualifications needed to thrive as a provider dispute resolution specialist?

To thrive as a Provider Dispute Resolution Specialist, you need a solid understanding of healthcare claims processing, regulations, and dispute resolution practices, often supported by a degree in healthcare administration or a related field. Familiarity with claims management systems, medical coding software, and regulatory tools like HIPAA compliance platforms is typically required. Strong analytical thinking, attention to detail, and effective communication skills help facilitate negotiations and resolve conflicts efficiently. These skills are crucial for ensuring accurate, timely dispute resolution while maintaining compliance and positive provider relationships.

What are some typical challenges a provider dispute resolution specialist faces when resolving claims disputes, and how can they be effectively managed?

Provider Dispute Resolution Specialists often encounter challenges such as interpreting complex insurance policies, managing high volumes of cases, and navigating differing expectations between providers and payers. Effective management involves maintaining strong communication skills, staying up-to-date with regulatory changes, and developing expertise in claims adjudication processes. Building collaborative relationships with internal teams and external stakeholders also helps ensure disputes are resolved efficiently and fairly.

What is the difference between Provider Dispute Resolution Specialist vs Claims Analyst?

AspectProvider Dispute Resolution SpecialistClaims Analyst
CredentialsRelevant certifications in healthcare or dispute resolution, often with industry-specific trainingTypically requires a degree in healthcare administration, finance, or related fields
Work EnvironmentHealthcare organizations, insurance companies, or third-party dispute resolution firmsInsurance companies, healthcare providers, or administrative offices
Employer & Industry UsageUsed in healthcare and insurance sectors to resolve provider disputesCommonly employed in insurance and healthcare to process and analyze claims

The Provider Dispute Resolution Specialist focuses on resolving disputes between healthcare providers and payers, often involving negotiation and specialized knowledge. Claims Analysts primarily review, process, and analyze insurance claims to ensure accuracy and compliance. While both roles work within the healthcare and insurance industries, the Specialist emphasizes dispute resolution, whereas the Analyst concentrates on claims processing and data analysis.

What cities are hiring for Provider Dispute Resolution Specialist jobs?

Cities with the most Provider Dispute Resolution Specialist job openings:

What states have the most Provider Dispute Resolution Specialist jobs?

States with the most job openings for Provider Dispute Resolution Specialist jobs include:

What are popular job titles related to Provider Dispute Resolution Specialist jobs?

For Provider Dispute Resolution Specialist jobs, the most frequently searched job titles are:

Provider Dispute Resolution Specialist jobs near you

Provider Dispute Resolution Specialist

San Bernardino, CA • On-site

LSMA Management Inc
See more jobs at LSMA Management Incexternal

$33.50 - $39.50/hr

Full-time

Re-posted 13 days ago

Job description

Description

JOB SUMMARY

The Provider Dispute Resolution Specialist is responsible for the accurate, timely, and compliant review and resolution of provider disputes and appeals related to claims adjudication, reimbursement, coding, and authorization determinations. This role ensures compliance with applicable California state and federal regulations, contractual obligations, and internal policies while supporting positive provider relations.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS


Education/Training

Minimum: High school diploma or equivalent.

Preferred: Coursework or training in healthcare administration, medical billing, or related field.

Experience 

Minimum: 5+ years of experience processing managed care health claims.

Preferred: 2+ years of direct Provider Dispute Resolution and/or Appeals experience within Medicare, Medi-Cal/Medicaid, Commercial, PPO, and/or HMO environments.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.


Skills, Knowledge & Abilities

Strong working knowledge of managed care claims operations and regulatory requirements, including dispute and appeal timeliness standards.

Proficiency with medical coding concepts (ICD-10, CPT, HCPCS, DRG, ASC).

Experience with UB-04 and CMS-1500 claim forms.

Ability to analyze complex data, identify discrepancies, and apply contract terms accurately.

Strong written and verbal communication skills in English.

Effective time management skills with the ability to manage competing priorities and workload volumes.

Intermediate proficiency with Microsoft Office applications, including Word and Excel.

Demonstrated problem-solving skills and attention to detail.


PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. This position primarily involves sedentary work with routine use of a computer and standard office equipment. The role may require occasional light physical activity (up to 10 pounds) and brief periods of bending, reaching, or filing. The employee must be able to maintain concentration for extended periods, analyze detailed information, and meet regulatory deadlines, with or without reasonable accommodation.


PAY RANGE

$33.50 - $39.50 / hourly

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