TEMP BPO Senior Representative

NTT
Plano
Workplace: OnsiteFull timeFunction: Solutions Engineering & Sales EngineeringSkills: ["Clear written communication","Compliance focus","Organization","Attention to detail","Stakeholder communication"]

Review and resolve provider payment disputes for denied or incorrect claims by interpreting provider and health plan contracts. Ensure accurate claim determinations using RBRVS and Medicare guidelines, adjusting claims (including interest/penalties where applicable) and identifying system or eligibility configuration issues. Communicate dispute outcomes to providers with compliant written letters, maintain accurate records in a Provider Dispute Database, monitor warning reports, and support departmental quality and compliance.

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FursaFursa
NTT
NTT
1 week ago

TEMP BPO Senior Representative

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Last checked: 3 hours agoStatus: Live

Job Summary

Review and resolve provider payment disputes for denied or incorrect claims by interpreting provider and health plan contracts. Ensure accurate claim determinations using RBRVS and Medicare guidelines, adjusting claims (including interest/penalties where applicable) and identifying system or eligibility configuration issues. Communicate dispute outcomes to providers with compliant written letters, maintain accurate records in a Provider Dispute Database, monitor warning reports, and support departmental quality and compliance.
Location: Plano
Workplace: Onsite
Employment Type: Full time
Job Function: Solutions Engineering & Sales Engineering
Seniority: Mid level

Key Responsibilities

  • •Review written provider dispute requests for denied or incorrect payments and determine outcomes based on contract terms and health plan financial responsibility.
  • •Apply RBRVS and Medicare guidelines and adjust claims as appropriate, including calculating interest and penalties when applicable.
  • •Identify potential issues related to system configuration, benefits, eligibility, and authorizations, and route them to the correct internal department with supporting documentation.
  • •Communicate dispute results to providers using system-formatted letters in accordance with departmental guidelines and complete provider education calls based on outcomes of PDR.
  • •Maintain and update the Provider Dispute Database with dispute documentation and resolution outcomes, monitor warning reports daily, and support quality and compliance standards.

Key Requirements

  • •Ability to interpret provider and health plan contracts to determine accurate payment or denial of claims based on contractual and financial responsibility terms.
  • •Experience applying RBRVS and Medicare guidelines to contracted and non-contracted provider claims and denials.
  • •Ability to adjust claims as needed, including calculating applicable interest and penalties.
  • •Ability to identify issues related to system configuration, benefits, eligibility, and authorizations impacting accurate claim processing and escalate to the correct internal department with documentation.
  • •Strong attention to compliance and accurate documentation of disputes in a Provider Dispute Database for reporting purposes.
Experience:HealthcareHealth insuranceClaims processing
Skills:Clear written communicationCompliance focusOrganizationAttention to detailStakeholder communication
Tech Stack:Provider Dispute Database

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