Job Summary Provides support through the investigation and resolution of disputes related to provider appeals, ensuring that claims adhere to correct billing standards and regulations. Job Duties
Job Summary Provides support through the investigation and resolution of disputes related to provider appeals, ensuring that claims adhere to correct billing standards and regulations. Job Duties
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Remote Dispute Resolution information
What is a Remote Dispute Resolution job?
A Remote Dispute Resolution job involves mediating conflicts, handling claims, or resolving disputes between parties through online platforms, emails, or virtual meetings. Professionals in this role may work in legal, financial, or customer service settings, helping clients settle disagreements without in-person interaction. The job requires strong communication, negotiation, and problem-solving skills. Many roles involve working for companies, legal firms, or independent mediation services.
What are some typical challenges faced by professionals in remote dispute resolution roles?
Professionals in remote dispute resolution often face challenges related to building rapport and trust between parties in a virtual setting, as non-verbal cues can be harder to interpret online. Technical issues, such as unstable internet connections and unfamiliarity with digital mediation tools, may also arise. Additionally, maintaining confidentiality and ensuring all parties feel heard and respected can require extra attention when working remotely. However, with strong communication strategies and technical preparedness, these challenges are manageable and can even lead to more flexible, widely accessible resolution processes.
What are the key skills and qualifications needed to thrive in the Remote Dispute Resolution position, and why are they important?
To thrive in Remote Dispute Resolution, you need strong analytical abilities, negotiation skills, and a background in conflict management or law, often supported by a degree or relevant certification such as ADR (Alternative Dispute Resolution). Familiarity with mediation software, secure virtual meeting platforms (like Zoom or Microsoft Teams), and case management systems is typical in this role. Excellent written and verbal communication, impartiality, and active listening are essential soft skills for effective dispute resolution. These competencies ensure fair and efficient handling of disputes in virtual environments, maintaining professionalism and productive outcomes for all parties involved.
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Full-time
Posted 20 days ago
Molina Healthcare rating
8.0
Based on 192 frontline employees who took The Breakroom Quiz
146th of 261 rated insurance
Job description
Job Summary
Provides support through the investigation and resolution of disputes related to provider appeals, ensuring that claims adhere to correct billing standards and regulations.
Job Duties
- Reviews coding-related provider claims denials by systematically examining medical records, denial reasons, submitted claims, and claim history, in accordance with applicable state, federal, and Molina guidelines, rules, and protocols, to determine whether the documentation substantiates the services rendered.
- Conducts independent audits of non-medical records to verify billing accuracy, making decisions within designated authority to either overturn or uphold denials in a timely manner.
- Generates and communicates the determination to the provider using appropriate letter language and providing any necessary guideline links.
- Identifies, documents, and communicates any identified coding errors or inconsistencies, collaborating with appropriate internal department(s)to capture and track issues to ensure precise code editing and compliance.
- Completes data points within internal applications to comply with auditing requirements used within the departments of Molina.
- Actively participates in the enhancement of departmental processes to maintain alignment with current coding regulations and guidelines, while also refining internal procedures.
Job Qualifications
REQUIRED QUALIFICATIONS:
- At least 2 years of experience in medical coding or billing.
- Active and unrestricted Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification.
- Strong attention to detail and ability to independently read and comprehend the details of medical records.
- Comfortable working in a production-centric environment with high quality standards.
- Ability to use Microsoft Office including Outlook, Word, and Excel.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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About Molina Healthcare
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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Long Beach, CA, US
Year founded
1980