TEMP BPO Senior Representative

NTT
Plano
Workplace: OnsiteFull timeFunction: Solutions Engineering & Sales EngineeringSkills: ["Communication","Attention to detail","Compliance mindset","Problem identification","Work prioritization"]

Review and resolve provider disputes for denied or incorrect payments by interpreting provider and health plan contracts and applying RBRVS and Medicare guidelines. Adjust claims, calculate interest and penalties when applicable, and route system or eligibility/configuration issues to the right internal teams. Communicate dispute decisions in writing, monitor warning reports for compliance, maintain the Provider Dispute Database, and support provider education based on outcomes.

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FursaFursa
NTT
NTT
1 month ago

TEMP BPO Senior Representative

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 15 hours agoStatus: Live
Reposted: similar role first listed 1 month ago

Job Summary

Review and resolve provider disputes for denied or incorrect payments by interpreting provider and health plan contracts and applying RBRVS and Medicare guidelines. Adjust claims, calculate interest and penalties when applicable, and route system or eligibility/configuration issues to the right internal teams. Communicate dispute decisions in writing, monitor warning reports for compliance, maintain the Provider Dispute Database, and support provider education based on outcomes.
Location: Plano
Workplace: Onsite
Employment Type: Full time
Job Function: Solutions Engineering & Sales Engineering
Seniority: Mid level

Key Responsibilities

  • •Review written dispute requests from providers regarding denied or incorrect payments based on contractual and non-contractual provider scenarios.
  • •Ensure accurate claims adjustments, including interest and penalty calculations when applicable.
  • •Identify and escalate system configuration, benefits, eligibility, authorization, or related issues to the appropriate internal department with required documentation.
  • •Plan and organize workload for efficient and compliant resolution of disputes, including monitoring warning reports daily.
  • •Maintain and update the Provider Dispute Database with dispute details and resolution outcomes for reporting, and request special check runs as needed for compliance.

Key Requirements

  • •Ability to interpret provider and health plan contracts to ensure accurate payment or denial based on contract and health plan financial responsibility terms.
  • •Knowledge of RBRVS and Medicare guidelines as applied to contracted and non-contracted providers.
  • •Ability to identify potential issues (e.g., system configuration, benefits, eligibility, authorizations) affecting claims processing accuracy and forward them with documentation to the correct internal department.
  • •Ability to communicate dispute decisions to providers in writing using system-formatted letters in accordance with departmental guidelines.
  • •Maintain minimum departmental standards for quality and quantity of appeals received.
Skills:CommunicationAttention to detailCompliance mindsetProblem identificationWork prioritization

Company Brief

NTT
Dimension Data, operating under NTT Ltd, provides managed IT services, cloud and data center solutions, networking, cybersecurity, and digital transformation services to enterprise customers worldwide.
Industry: Professional Services
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Established Company
Valuation: Public Company (Market Cap in USD)
Headquarters: London, United Kingdom
Founded: 1983
WebsiteLinkedIn