Benefits:

Responsibilities and duties:

Promptly review, address and schedule Peer-to-Peer (“P2P”) for physician advisors on all clinical disputes, unless otherwise noted.
Follow up (by phone, company email or by accessing Payer Portals) to facilitate information timely to meet all P2P deadlines via only HIPAA-compliant methods.
Obtain or confirm, as necessary, the payer fax numbers and emails needed to review and address clinical disputes.
Communicates and resolves clinical dispute and P2P barriers for timely and appropriate follow-up and resolution, with escalation to leadership, UR Team and PA Team as needed.
Collaborate with all other roles or departments, including external partners (payors) to support essential UR duties to ensure successful and expedient management of concurrent denials. Be knowledgeable of Tenet and CRC metrics, and work with related teams to ensure strategic collaboration to achieve target goals.

Qualifications:

Skills required include excellent organizational skills, excellent verbal, and written (typing) communication skills, demonstrated problem solving skills, and computer literacy
Ability to concentrate and accomplish tasks with explicit accuracy and ability to meet deadlines.
Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency
High school graduate or equivalent
2 years of experience in clerical or healthcare field

Working Conditions:

Physician Advisor Clinical Dispute Coordinator

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